ENTEROBACTERIACEAE

Introduction
Family Enterobacteriaceae is a large
heterogeneous group of Gram negative rods,
whose natural habitat is the intestinal tract of
humans and animals;
The members of this family exhibit a wide
range of biochemical and antigenic
heterogenicity;

Introduction
Some like Escherichia coli are part of normal
flora and incidentally cause disease;
Opportunistic pathogens
Nosocomial infections : also multi drug resistant
Others like Salmonella and Shigella are
regularly pathogenic to man;
Most important group of GNBs isolated from
various specimens in clinical microbiology lab.


Definition of
Family Enterobacteriaceae
(Topley & Wilsons)
Gram negative, non-sporing rods;
Often motile, usually by means of peritrichate flagella;
capsulate or noncapsulate;
easily cultivable on ordinary laboratory media;
Aerobic and facultatively anaerobic.
All species ferment Glucose with production of acid or acid
and gas;
reduce nitrates to nitrites;
oxidase negative and catalase positive ( except Shigella
dysenteriae type I );
Typically intestinal parasites of man and animals;
Taxonomy
Complex and rapidly changing since the
introduction of nucleic acid hybridization and
sequencing techniques;
The primitive method is to classify these
organisms into 3 groups based on their action
on Lactose ( the ingredient of the most popular
culture medium for enteric bacteria, the
MacConkeys lactose bile salt agar)
3 groups based on Lactose fermentation
Lactose fermentors : coliforms
Colon bacillus (Escherichia coli) and others like
Klebsiella, Hafnia etc.
Late lactose fermentors : paracolon bacilli
Usually commensals and ferment lactose slowly
Shigella sonnei is a pathogen;
Non Lactose fermentors :
Major intestinal pathogens : Salmonella, Shigella

Taxonomy : 3 systems of nomenclature
1. Bergys manual of systematic bacteriology(1984):
20 genera and >70 species
2. Ewing (1986) : 21 genera and 75 species
3. Farmer and Kelly (1991) : 26 genera and 86 named
sepcies and 8 enteric groups;
Currently : >31 genera and about 139 species were
identified;
Classification scheme
Family is first classified into a major
subdivision, group or tribe;
Each tribe consists of one or more genera;
Each genus has one or more subgenera and
species;
Each species can be further classified into
types : biotypes, serotypes, bacteriophage
types, coicin types etc.
Current classification scheme
(Konemans Diagnostic Microbiology)
Tribe I : Escherichiae :- Escherichia, Shigella
Tribe II : Edwardsiellae :- Edwerdsiella
Tribe III: Salmonellae :- Salmonella
Tribe IV : Citrobacteriaceae :- Citrobacter
Tribe V : Klebsiellae :- Klebsiella
Tribe VI : Proteae :-Proteus, Morganella, Providencia;
Tribe VII: Yersineae :-Yersinia
Others : Ewingella, Tatumella etc.
Morphology and identification
Usually short Gram negative rods; may be motile;
Klebsiella and Enterobacter are capsulated;
On culture, form smooth colonies with distinct edges;
capsulate organisms produce mucoid colonies;
These are Oxidase negative and catalase positive;
reduce nitrates; ferment Glucose;
Several other biochemical tests for identification and
differentiation; (eg. Sugar fermentation tests,IMViC,
Urease, Gelatin Liquefaction, amino acid
decarboxylation etc.)

Antigenic structure
Have a complex
antigenic structure;
>150 heat stable
somatic O antigens
>100 heat labile
K(capsular) antigens;
>50 flagellar H antigens
O antigens
Most external part
of cell wall
lipopolysacharide
consists of repeating
units of
polysacharide;
Heat resistant;

O antigens
Each organism can carry several O antigens;
Most Shigellae share one or more O antigens
with E.coli;
E.coli may also cross react with some species
of Klebsiella and Salmonella;
Occassionally, O antigens may be associated
with specific human disease : eg. Specific O
types of E.coli are associated with UTI.

K (Capsular ) antigens
(Kapsel : German for Capsule)
External to O antigen;
Polysacharides in Klebsiella and E.coli
Proteins in others;
Interfere with agglutination by O antisera;
May be associated with virulence:
K ag of E.coli: attachment to uroepithelial cells
E.coli with K1 ag : neonatal meningitis
K1 and K2 of Klebsiella : RTI
H (Flagellar) antigen
Heat labile;
Can be denatured by heat or alcohol;
Antigenicity determined by aminoacid
sequence in flagellar protein, flagellin;
The antigen may exist as either or both of two
phases : Phase I or Phase II;
They may also change for one phase to another
phase : Phase variation
Bacteriocin production
Bacteriocins are virus like bactericidal substances
produced by certain strains of bacteria and inhibit the
growth of other strains of same or closely related
species; Ex :
Colicin : E.coli;
Marcescins : Serratia
Proticin : Proteus
Strains producing bacteriocins are resistant to their
own bacteriocin : these can be used for typing the
organisms;

Toxins or Enzymes
They have a compled
LPS in their cell wall.
This is Endotoxin;
Many Gram negative
enteric bacteria also
produce exotoxins;
Escherichia coli
Introduction
Named after Escherich, who first described the colon
bacillus as Bacterium coli commune;
(Theodar Escherich : 1857-1911 : German physician)
E.coli is the most common lactose fermenting enteric
colon bacilli ( coliform bacilli);
E.coli has been further divided into several biotypes
and serotypes;
Other less common species are :
E.fergusonii,E.hermanii and E.vulneris
E.blattae : found in the gut of cockroach
E.coli lives only in the intestines of animals or
man;
Excreted in feces and viable only for some
days in the environment;
Thus : detection of E.coli in drinking water
indicates :
Contamination with human or animal feces and
The pollution is recent one;



Introduction
Morphology
Morphology
Gram negative, straight rod
Measures : 1-3 x 0.4-0.7
Arranged singly or in pairs
Usually motile by Peritrichous
flagella
Some strains may be non motile
Fimbriae are also present
Some strains are capsulated
(especially isolated from extra-
intestinal infections)
Gram negative
Straight rods
Possess peritrichate
flagellae and fimbriae
Cell of Escherichia coli
with two flagella
and
numerous fimbriae
(type I pili).

Metal shadowing
Bar: 0.5 m.

(From Schmitt, R., 1997,
BIUZ 27, 40-47).
Cultural characteristics
Aerobe and facultative anaerobe;
Optimum temperature : 37
0
C;
Good growth on ordinary media;
Growth on Nutrient agar :
Large(2-3 mm), circular, smooth, moist , greyish
white, transulent colonies , easily emulsifiable in
saline : S (smooth) form
R (rough) variants give : irregular colonies with
dull surface; autoagglutinable in saline;


SR (Smooth to Rough) variation:
On repeated subcultures;
Associated with loss of surface antigens and
virulence;
Many pathogenic strains are :
Capsulated :Polysaccharide capsule
Hemolytic on Blood agar
Cultural characteristics
Cultural characteristics
On MacConkeys agar :
produce bright pink
colonies due to Lactose
fermentation;
Growth is inhibited on :
selective media such as :
DCA or SS agar

Biochemical reactions
Ferment : glucose, lactose, mannitol,maltose
with production of acid and gas;
Typical strains do not ferment sucrose;
IMViC : + + - -
Gelatin not liquefied, H
2
S not formed;
Urease : negative;
Growth does not occur on KCN medium

Antigenic structure
3 types of antigens:
> 170 somatic O antigens (LPS)
>75 flagellar H antigens (mostly monophasic)
>100 capsular K antigens ( acidic polysaccharide
located in the envelope or in microcapsule; two
types : Type I (heat stable) and Type II (heat lable)
Serotype of a strain is designated as : the no of
particular antigen;
Ex.: O111:K58:H2

Virulence factors
Two types :
Surface antigens
Toxins
Surface antigens
Somatic O antigen (LPS) :
Endotoxic activity
Protects from phagocytosis
and Complement
K antigen:
Protects from phagocytosis
and Complement
Not effective in the
presence of antibody to K
antigen or antibody to both
K and O;

Escherichia coli
Conjugation
Surface antigens - Fimbriae
Type I fimbriae : chromosome encoded
Mediate adhesion to cells that contain mannose
Adhesion plays an important role in pathogenicity
Plasmid encoded filamentous structures
resembling fimbriae : cause mannose resistant
hemagglutination
Colonisation Factor antigen (CFA)-ETEC
P fimbriae: binds specifically to P blood group
antigen on human RBC and uroepithelial cells;
Surface antigens - Siderophores
Expression of siderophores: Enterobactin
Removes Iron from mammalian iron transport
proteins such as transferrin , lactoferrin;
Seen in strains isolated from septicemia,
pyelonephritis, UTI
Toxins
Two types of exotoxins :
Hemolysins
Enterotoxins
Hemolysin : more commonly produced by
virulent strains but not relevant in pathogenicity;
Enterotoxins : in the pathogenesis of diarrheas
Heat labile toxin (LT)
Heat stable toxin (ST)
Shiga like toxin (SLT) or Verotoxin


Heat labile toxin (LT)
Discovered by De & colleagues in 1956 in
isolates from adult diarrhea cases in Calcutta;
Resembles Cholera toxin (but, cholera toxin is
100 times more potent);
Subunit protein toxin with one A(active) subunit
and five B(binding) subunits;
Subunit A is made up of A1 and A2 peptides,
bound by a disulfide bridge;
Mechanism of action of LT
Binds to GM
1
ganglioside receptors on
intestinal epithelial cells with B subunits;
Insertion of B subunits into host cell
membrane causes a transmembrane channel;
Toxic subunit A enters cytoplasm through this
channel;
A1 is released from A subunit;

A1 activates adenylate cyclase
Over production of Cyclic AMP
Inhibition of uptake of Na+ and Cl- by
the cells lining the villi
Loss of water and electrolytes into
gut lumen
Diarrhoea
Detection of LT
In vivo tests : Ligated rabbit ileal loop method
Inj. of culture filtrate of E.coli into closed ligated
loops of rabbit ileum induce outpouring of fluid
and ballooning of loops;
In vitro tests:
CHO (Chinese Hamster ovary) cells: elongation
Y1 (mouse adrenal) cells: rounding
Serology : ELISA, Bikens precipitin test etc.
Molecular : DNA probes
Heat stable toxin (ST)
First identified in 1970;
Low Mol.wt polypeptide; Poorly antigenic;
2 major classes : ST-I(ST
A
) and ST-II (ST
B
)
ST
A
: acts rapidly
activates guanylate cyclase increase in
cGMP fluid loss;
Infant mouse test : standard method for detection
Fluid accumulation in the intestines of infant mice
within 4 hrs
Feature ST-I(ST
A
) ST-II (ST
B
)
Menthol Soluble Insoluble
Mechanism Increase cGMP unknown
Infant mouse test + -
Rabbit ileal loop + -
Pig intestinal loop + +
Verotoxin/Verocytotoxin (VT)
First detectd in 1977 by its cytotoxic effect on
vero cells (African green monkey kidney cell
lines);
Also known as : Shiga like toxin (SLT)
As it is similar to toxin produced by Shigella
dysenteriae Type I ;
Phage encoded;
Comprises A(active) and B(binding) subunits;
Mechanism of action of VT
B-subunit mediates specific binding and receptor
mediated uptake of the toxin by various mammalian
cells including kidneys;
Vascular endothelial cells may be primary target;
A subunit cleaved into A1 and A2;
A1 inactivates host cell 60S ribosome and interferes
with protein synthesis;
VT2 is an antigenic variant and not neutralized by
Shiga antitoxin;
Summary of virulence factors
Surface antigens :
O (LPS) : endotoxin , protects from phagocytosis;
K: protects from phagocytosis;
Fimbriae :
Colonisation factor antiges,P fimbriae : adhesion
Siderophores : enterobactin
Exotoxins : hemolysins and enterotoxins
LT : resembles cholera toxin; increase cAMP
ST : increse cGMP
VT or SLT : cytotoxic and inhibit protein synthesis
Clinical syndromes
Urinary tract infections
Diarrhea
Pyogenic infections
Septicemia
Urinary tract infections
Most common cause of naturally acquired UTI;
Strains that cause UTI often originate from the
gut of the patient:
Infection is usually ascending;
Serotypes are those found in feces;
Infection with one serotype at one time;
Recurrences may be with different serotypes;
Infection of the upper UTI (eg. Pyelonephritis)
may be hematogeneous;(strains with K ag.).

UTI- Predisposing factors
Females > males
Short and wide urethra;
Pregnancy : hormonal changes, pressure on U.tract
Urinary stagnation:
Urethral stricture
Stones
Congenital malformation
Neurological disorders
Prostatic enlargement
Iatrogenic: catheterisation, cystoscopy etc.
Specimen collection
Careful anogenital toilet to avoid contamination;
Midstream sample into a sterile wide mouthed
container;
Processed without delay;
If delay > 2hrs : refrigerate the sample
Catheterization for the sake of collection of the
sample NOT justified; but sample may be taken if
already catheterized for any other reason;
Asymptomatic bacteriuria
5-7% of pregnant women have UTI without
any symptoms ;
If untreated, they may progress into
symptomatic infection, pyelonephritis,
Hypertension complicating pregnancy and also
prematurity and perinatal death;
Significant bateriuria (Kass)
In the presence of active UTI, the urine
contains 10
5
or more organisms per ml;
Counts < 10,000/ml : due to contamination;
10,000-1,00,000/ml : equivocal; repeat sample;
BUT, even low counts are significant if:
Patient on antibiotics or diuretics;
If the isolate is S.aureus
Culture
Quantitative culture :
Serial tenfold dilutions tested by pour plate or
surface plating method; complicated;
Semiquatntitative : convenient
Using standard calibrated loop
Media :Blood agar, MacConkeys agar (usually);
Antibiotic sensitivity test done on the isolates;
Antibody coated bacteria test:
bacteria coated with antibody are present in urine
only if kidney is involved;
Detected by - IF , Coagglutination
Diarrhea
Some strains may cause GI disease ranging from self
limiting diarrhea to hemorrhagic colitis;
Five different groups of diarrheagenic E.coli are
identified:
EPEC : Enteropathogenic E.coli
ETEC : Enteotoxigenic E.coli
EI EC : Enteroinvasive E.coli
EHEC /VTEC: Enterohemorrhagic E.coli or
Verocytotoxin producing E.coli;
EAggEC : Enteroaggregative E.coli


EPEC : Enteropathogenic E.coli
Diarrhea in infants and children; also in adults;
Institutional out breaks ; sporadic cases also;
Common serogroups : O25, O55, O111 etc.
Colonization in the upper part of small
intestine

Pathogenesis: EPEC
Bacilli are adherent to mucosa and surrounded
by cuplike projections, pedestals of
enterocyte surface;
Brush border and microvilli lost in the areas of
attachment;
Adhesion to gut wall and subsequent mucosal
damage : attaching and effacing lesion;
The strains are termed as : AEEC (attaching
and effacing E.coli) or enteroadherent E.coli;

Detection
Stool culture
Isolate and identify E.coli
Agglutination :polyvalent sera
Agglutination :monovalent sera
Other methods :
Adherence to cultured HEp2(human epithelial) cells
DNA probes
ETEC : Enterotoxigenic E.coli
Serotypes : O6, O8, O15, O25 etc.
Endemic in developing countries;
All age groups;
Mild diarrhea to fatal cholera like illness;
Traveler's diarrhea : persons (from
developed countries) who visit endemic areas
may suffer from attacks of ETEC diarrhea;
Pathogenesis:Virulence factors :

Plasmid encoded Enterotoxins : LT and ST;
LT (Heat labile toxin) : increased cAMP and
outpouring of water and electrolytes;
ST (heat stable toxin): increases cGMP;
BUT : toxin production itself is NOT sufficient;
Adhesive factors :
Fimbriae
Colonisation fator antigens: CFA I,II,III and IV;

Detection of LT and ST
LT :
In vivo : ligated rabbit ileal loop;
In vitro : CHO cells(elongation),Y1 cells (rounding)
Serological : ELISA, Biken precipitin test
Molecular : DNA probes
ST : infant mouse test
EIEC : Enteroinvasive E.coli
Serotypes : O 28 ac, O112 ac, O124, O136 etc.
Dysentery like illness, similar to Shigellosis;
All ages; common in children and travelers;
Transmission: usually food borne;
Mechanism : penetrate epithelial cells and
damages them;

Pathogenesis of EIEC
Infection by ingestion
Resistant to gastric acid and bile : reach large intestine
Multiply in large intestine and attach to epithelial cells
Carried in to cell by endocytosis
Lyse endocytic vacuole and multiply in the cell and kill it
Spread to neighbouring cells
Tissue destruction and inflammation
Dysentery
Cultural characteristics of EIEC
Like Shigella, most EIEC strains are :
Non-motile
NLF or LLF
No gas;
O antigens cross react with Shigella;
Called atypical E.coli strains (formerly called
Alkalescens Dispar group);
Typical E.coli also cause such illness;
Detection of EIEC
Serenys test : instillation of a suspension of
freshly isolated EIEC in to the eyes of a guinea
pig ( mice may also be used) leads to
keratoconjunctivitis;
Ability to penetrate HeLa or HEp-2 cells;
VMAELISA : virulence marker antigen ELISA;
Gene probes

VTEC : Verotoxigenic E.coli
Also called EHEC (enterohemorrhagic E.coli);
Typical serotype : O157:H7
Associated with :
Mild to bloody diarrhea;
Hemorrhagic colitis;
HUS (Hemolytic uremic syndrome)
Particularly in young children and elderly;
Produce VT(verotoxin) or SLT(Shiga like toxin)

THIS BOOK IS DEDICATED TO
Those families who have suffered
From the scourge of E.coli O157:H7
And other food borne illnesses.
-Robin Cook
Pathogenesis of EHEC
E.coli O157:H7 ingested
Contaminated food
Adher to Disrupt brush border
Abdominal cramps
Non-bloody diarrhea
Local and systemic effect of toxin
Hemorrhage and edema in lamina propria
with superficial necrosis
Bloody
diarrhea
Fever absent or
Low grade
Resolution
95%
5%
Hemolytic Uremic syndrome
Verotoxin enters blood
Vascular endothelial damage
Platelet aggregation
Ischemic damage to colon and kidneys
Proper cooking
Prevents it.
Laboratory diagnosis of EHEC
Stool: Bloody diarrhea
Culture: on SMAC (Sorbitol MacConkey agar)
Contains sorbitol instead of lactose;
O157:H7 does not ferment sorbitol whereas other
strains of E.coli ferment it.
Agglutination by O157 antiserum;
VT: cytotoxic effects on Vero or HeLa cells;

E.coli strain O serogroup Disease Pathogenesis
EPEC 18,26,44,55 Diarrhea in
infants
Attaching and
effacing lesion
ETEC 6,8,15,25 .. watery diarrhea
Travelers diar.
LT, ST
adhesins
EIEC 28ac,112ac,
124,136..
Dysentery like
illness
Epithelial cell
invasion
VTEC 157:H7 Bloody
diarrhea,HUS
VT1, VT2
EAEC: Enteroaggregative E.coli
Serotypes : most are O-untypable;
Appear aggregated in a stacked brickpattern
on HeLa cells or glass(cover slip);
Associated with persistent diarrhea;
Produce EAST-1 (enteroaggregative heat stable
enterotoxin-1);
Cause shortening of villi, hemorrhagic necrosis,
mild edema in submucosa;
Watery, mucoid non-bloody diarrhea
Other infections
Pyogenic infections:
Most common cause of intra abdominal infections
like peritonitis;
Pyogenic infections of perianal area;
Neonatal meningitis;
Septicemia : blood stream invasion;
Nosocomial infections :
septicemia/bacteremia, endotoxic shock,
pneumonia


Treatment and prevention
Careful selection of antibiotic based on
antibiotic sensitivity pattern to avoid
emergence of drug resistance;
Maintenance of fluid and electrolyte balance;
Care in selection, preparation and consumption
of food and water;

Tribe Proteae : the proteus bacilli
These are lactose non-fermentors and exhibit
pleomorphism (after Gk god , Proteus)
They may present as intestinal commensals
and can cause opportunistic infections;
3 genera :
Proteus
Morganella
Providencia
Genus : Proteus
Gram negative
Pleomorphic rods;
Most cells of 3
Some are filamentous
Proteus
Proteus
Actively motile
By means of Peritrichate flagella
Devided into 4 species :
Proteus mirabilis
Proteus vulgaris
Proteus penneri
Proteus myxofaciens
Cultural characteristics
The grow well on ordinary media;
Most strains do not form discrete colonies on
Nutrient agar, but they exhibit spreading
growth on the surface of the agar plate;
They spread on the surface of the agar plate in
successive waves to form a thin filmy layer in
concentric circles;
This is called, swarming
This swarming is a
characteristic
feature of Proteus;
the growth has a
characteristic
fishy or seminal
odour
Mechanism of swarming
(Williams and Schwarzhoff, 1978)
After 2-4 hrs of growth, the normally
sparse flagellate short (2-4)bacilli at the
edge of the colony are stimulated to :
Continue growing while septum
formation and cell division are inhibited;
Synthesise more flagellae and to
Produce acidic polysacharide slime,
which assist in the movement of cells
across agar surface;
The swarm cells may be as long as 80;
After 2-4 hrs the cells
enter a phase of
consolidation, where
they become normal
short bacilary forms;
after some period of
growth, swarming is
stimulated again.
This cyclical swarming and consolidation will give
rise to a series of concentric circles of growth over
the agar surface;
Problems due to swarming
Due to swarming, the film of growth covers
most or all of the agar surface and the colonies
of other bacteria as well the isolation of
bacteria from mixed growth becomes difficult;

The solution..?
Methods to inhibit swarming
Increasing conc. of agar : to 3-4% (firm agar);
By introducing anti-swarming agents :
Chloral hydrate (1:500)
Sodium azide ( 1:500)
Alcohol
Sulfonamides
Boric acid ( 1:1000)
Surface active agents or detergents
Best anti swarming agent : p-nitrophenyl glycerol
Swarming does not occur in :
MacConkeys lactose bile salt agar
DCA
CLED medium : due to defeciency of electrolytes
Due to bile salts
Biochemical characteristics
Produce powerful urease
Rapidly hydrolyse urea to ammonia and CO2
PPA reaction:
Possess phenyl alanine deaminase, which converts
phenyl alanine to phenyl pyruvic acid;
All members of the tribe Proteae possess these
two features. (except Providencia alcalifaciens,
which doesnt produce urease)
UREASE
Positive Negative
Proteus is a strong urease
Producer;
Gives a rapid urease reaction
Urea
Ammonia + CO2
Urease
Pink colour in
Christensens urease agar
Other Biochemical reactions
Most strains are :
MR positive and VP negative;
Resistant to KCN;
Produce H
2
S;
Produce acid and gas from Glucose
Does not ferment Lactose, dulcitol;
Lysine decarboxylase and arginine
dehydrolase are absent;
Produce gelatinase;
Do not form -galactosidase (ONPG
negative)
Indole :

P.vulgaris Positive
P.mirabilis - negative
Proteus vulgaris
H
2
S +
Indole
positive
Ornithine
decarboxylase
Negative
Urease
+
PPA +
ONPG -
Test P.mirabilis P.vulgaris

Gas from Glucose + +
Urease + +
PPA + +
Orn.decarboxylase + -
Indole - +
H
2
S + +
Gelatinase + +
Antigenic structure
Possess somatic O and flagellar H antigens;
Historical importance :
Weil&Felix(1916) observed that, the flagellar strains
growing on agar formed a thin surface film on the agar
surface, resembling the mist produced by breathing on
glass named this variety as Hauch form (Hauch=film
of growth);
Non-flagellated strains grew as isolated colonies without
surface film and called as Ohne hauch (without film of
breath);
These are abbreviated as : H and O forms;
Later these were used to designate the flagellar and somatic
antigens of other bacteria also;
The Weil-Felix reaction
Certain nonmotile strains of Proteus, called
X-strains, were agglutinated by sera from
typhus fever patients ;
This is : Heterophile agglutination reaction;
This is due to : sharing of an alkali-stable
carbohydrate antigen by some rickettsiae
and by certain strains of Proteus;
OX19 and OX2 of P.vulgaris
OXK of P.mirabilis
Typing of Proteus
Serotyping
Bacteriophage typing
Bacteriocin typing (Proticin typing)
Dienes phenomenon: Dienes,1946
When different strains of Proteus are allowed to
swarm towards each other, a line of completely or
partially inhibited growth is formed where the
spreading growths of incompatible strains meet;
Such line not formed between identical strains;
Habitat
Widely distributed in nature as saprophytes
Constitute an important flora of decomposing
animal matter, sewage, farces of man and
animals;
Frequently present over moist areas of skin;
Opportunistic pathogens;
Pathogenicity
Opportunistic pathogens;
Often responsible for nosocomial infections
Commonest cause of Urinary tract infections, (after
E.coli), especially in young males and elderly;
Others :
Infected wounds/abscesses ;
Meningitis
Septicemia
Osteomyelitis
Otitis media etc.
Pathogenicity
Predispose renal stone formation as it produces
a powerful urease:

rapid hydrolysis of Urea

urine becomes alkaline( ammonia and CO
2
)

promote stone formation;
Other genera of tribe Proteae
Genus Morganella
Genus Providencia

Genus Morganella : has only one species
Morganella morgagni
Commonly found in faeces
Occassionally cause UTI and nosocomial wound
infections
Do not swarm
Genus Providencia
3 species of clinical importance :
Prov.alcalifaciens found in faeces; Urease
negative;
Prov.stuartii UTI; as it is resistant to
disinfectants and heavy metals like Silver
sulphodiazine, it forms major flora of burns;
Prov.rettgeri normal faecal flora of reptiles
and amphibians; Nosocomial inf. of Urinary
tract, wounds, burns, and septicemia;
Lab diagnosis
Isolation and identification by culture;
Specimens :
Midstream urine for UTI
Pus for abscesses/wounds
Swab for wounds/otitis media etc.
CSF for meningitis
Generally resistant to many antibiotics;
Amikacin and Ciprofloxacin are usually
effective;
Proteus mirabilis:

H
2
S +
Indole
negative
Ornithine
decarboxylase
positive
Urease
+
PPA +
ONPG -