1Culture for Enterobacteriaceae
Eosin-Methylene agar (EMB) and MacConkey agar
2what organ is affected under Enterobacteriaceae
Enteral (intestines)
3Rapid Lactose Fermenters
Klebsiella
Escherichia
Enterobacter
4Late Lactose Fermenter
Citrobacter
Serratia
Salmonella arizonae
Shigella sonnei
Yersinia enterolitica
52 types of Non-Lactose Fermenters
PATHOGENIC and OPPORTUNISTIC
6PATHOGENIC Non-Lactose Fermenters
Salmonella
Shigella
Yersinia
7OPPORTUNISTIC Non-Lactose Fermenters
Proteus
Providencia
Morganella
Edwardsiell
8Enterobacteriaceae main manifestation
Diarrhea
9Enterobacteriaceae can also cause
Nosocomial infections (UTI, pneumonia,
bacteremia, sepsis)
103 types of diarrhea under enterobacteriaceaa
No Cell invasion
invasion of intestinal epithelial cells
invasion of lymph and blood
11Diarrhea in No cell invasion is caused by
enterotoxins
12Diarrhea in no cell invasion presentations
watery diarrhea without systemic symptoms
13bacteria under no cell invasion
Escherichia coli, Vibrio cholerae
14does diarrhea in invasion of intestinal epithelial cells have virulence factors?
yes
15diarrhea in invasion of intestinal epithelial cells presentations
systemic immune response; with fever, WBC in stool
16bacteria under diarrhea in invasion of intestinal epithelial cells
EIEC, Shigella, Salmonella enteritidis
17Normal flora of the colon
Escherichia coli
18Escherichia coli manifestation
Diarrhea, urinary tract infection, meningitis, sepsis
196 types of diarrhea under e. coli
Enterotoxigenic E. coli (ETEC)
Enterohemorrhagic E. coli (EHEC)
Enteroinvasive E. coli (EIEC)
Enteropathogenic E. coli (EPEC)
Enteroaggregative E. coli (EAEC)
20Known as TRAVELER'S DIARRHEA
ETEC
Enterotoxigenic E. coli
21TRAVELER'S DIARRHEA characteristic
cholera-like diarrhea; watery diarrhea
22Enterohemorrhagic E. coli Virulence Factor
Shiga toxin (STEC)/ Verotoxin (VTEC)
23Enterohemorrhagic E. coli presentation
HEMORRHAGIC COLITIS
24HEMORRHAGIC COLITIS characteristic
→Bloody diarrhea with severe abdominal pain, (-) fever
0157:H7 Strain → produces severe disease
→ Dysentery
→ Complication: HUS (Hemolytic-Uremic Syndrome)
Renal failure, Anemia, Thrombocytopenia
25Enteroinvasive E. coli presentation
SHIGELLA-LIKE DIARRHEA
26SHIGELLA-LIKE DIARRHEA characteristic
Bloody, pus-filled diarrhea, (+) fever
27Enteropathogenic E. coli presentation
INFANTILE DIARRHEA
28Enteroaggregative E. coli presentation
PERSISTENT WATERY DIARRHEA
29E coli is the most common cause of __
UTI
30other symptoms of e coli uti
Dysuria
CYSTITIS
PYELONEPHRIITs
312nd most common cause in neonates
MENINGITIS
32Normal flora of the GIT of animals, not in humans
Salmonella
33Salmonella reservior
Poultry and dairy products
34Salmonella MOT
Fecal-oral route
35Salmonella Diagnosis
Widal Test, Typhidot
363 types of salmonella
Salmonella typhi
Salmonella enteritidis
Salmonella cholerae-suis
37Salmonella presentations
Salmonellosis, bacteremia, typhoid fever
38aka enterocolitis
Salmonellosis
39Most common manifestation of Salmonella and is a watery diarrhea
Salmonellosis
40aka Enteric fever
Typhoid fever
41Typhoid fever causes
→ Prolonged high-grade fever
→ ROSE SPOTS: Rose-colored rash on the torso (rare)
→ Chronic carrier state: Gall bladder (asymptomatic but
infectious)
42Shigella
Never considered part of the intestinal flora
Always a pathogen
43Shigella virulence factor
Shiga Toxin
44Shigella Medically important members
a S. dysenteriae
b S. flexneri
c S. boydii
d S. sonnei
45Group A: Most common
S. dysenteriae
46Group B : Endemic in the Philippines
S. flexneri
48Group D : Late lactose fermenter
S. sonnei
49Shigellla presentation
SHIGELLOSIS
50aka : Bacillary Dysentery, bloddy, pus filled bact.
SHIGELLOSIS
51Shigella treatment
Self-limiting
Severe symptoms:
Ciprofloxacin (adults)
Azithromycin (children)
52Zoonotic infection
Yersinia pestis
53Yersinia pestis reservior
rats
54Yersinia pestis MOT
bite of rat or rat flea
55Yersinia pestis presentation
plague
56Most fatal pandemic recorded in history
plague
57BUBONIC PLAGUE
→ Enlarged, pus-filled lymph nodes in the groin and/
or axilla.
58SEPTICEMIC PLAGUE
hemorrhage, gangrenous fingers, nose, and toes
59PNEUMONIC PLAGUE
Septic emboli
60plague treatment
Aminoglycosides, Tetracycline
61Other type of gram negative bact
Yersinia enterolitica and noscomical infections
62NOSCOMIAL INFECTIONS
Klebsiella pneumoniae
Serratia
Proteus
63Yersinia enterolitica MOT;
fecal-orall route
64Yersinia enterolitica presentation
ENTEROCOLITIS
65Sometimes mistaken as appendicitis
ENTEROCOLITIS
66ENTEROCOLITIS treatment
Self-limiting; may give
Doxycycline
67Klebsiella pneumoniae
Pneumonia; red currant jelly like sputum
68Serratia
Pneumonia, UTI, Wound infection
702 types of Vibrio
V. cholerae, V. parahaemolyticus & V. vulnificus
71TCBS → yellow colonies
V. cholerae
72TCBS → green colonies
V. parahaemolyticus
73V. cholerae presentation
cholera
74cholera
→ Rice watery diarrhea
→ CHOLERA TOXIN induces the movement of water and sodium
into the intestinal lumen (osmotic pull)
75cholera TREATMENT:
• Fluid replacement
• Tetracycline to shorten
duration of infection
76V. parahaemolyticus PRESENTATION:
GASTROENTERITIS
77GASTROENTERITIS
→ Leading cause of diarrhea in Japan
→ Raw fishes
79TCBS → blue-green colonies
V. vulnificus
80Helicobacter pylori
Spiral-shaped bacterium
• Oxidase positive, motile
81Helicobacter pylori Virulence factor
Urease (liberates ammonia)
82Helicobacter pylori Diagnosis
Urea breath test
83Helicobacter pylori PRESENTATION:
. PEPTIC ULCER DISEASE
. HALITOSIS
. CHRONIC GASTRITIS
. RISK FACTOR FOR GASTRIC CANCER
84PEPTIC ULCER DISEASE
→ Duodenal or gastric ulcer; most common cause
85PEPTIC ULCER DISEASE TREATMENT:
• Triple therapy
• Quadruple therapy
86CHRONIC GASTRITIS
→ Most common cause h. pylori
87Campylobacter jejuni
• S-, gull winged- shaped bacterium
• Oxidase positive
88Campylobacter jejuni culture
: Skirrow Medium
89Campylobacter jejuni MOT:
Fecal-oral route
90Campylobacter jejuni presentation
diarrhea
91DIARRHEA
→ Similar with shigellosis (bloody diarrhea)
92DIARRHEA
Most Common Cause of Diarrhea in the World
1. Rotavirus
2. ETEC
3. Campylobacter jejuni
93DIARRHEA
TREATMENT:
• Macrolides or Fluoroquinolones
94Pseudomonas aeroginosa
Colonies emit a fruity smell (wound
dressings and agar are sniffed)
• Obligate gram-positive aerobe
95Pseudomonas aeroginosa Virulence Factors:
Capsule
• Exotoxin A: Major VF (protein
synthesis inhibitor)
• Pigments
96Pigments:
o PYOCYANIN
o PYOVERDIN
o PYORUBIN
o PYOMELANIN
97PYOCYANIN
Blue pigment,
stimulates inflammatory
response
98PYOVERDIN
fluorescent
siderophore
99PYORUBIN
dark red pigment
100PYOMELANIN
black pigment
101Pseudomonas aeroginosa PRESENTATION: (nosocomial infection)
1. PNEUMONIA
2. WOUND (BURN) INFECTIONS
3. OSTEOMYELITIS
4. CORNEAL INFECTION
5. SEPSIS
6. UTI
7. ENDOCARDITIS
8. MENINGITIS
102Pseudomonas aeroginosa TREATMENT
• Antipseudomonal Penicillin
• Cephalosporins (with coverage against
P. aeruginosa)
• Aminoglycosides