Ellas

Yersinia, Pasteurella, Francisella,

Legionella

Yersinia pestis

Gram negative safety pin

V and W antigens (on plasmid)
LPS endotoxin
Antiphagocytic capsular envelope (with I antigen)

Southwest US
May October
Reservoir = prairie dogs and squirrels

What is the lifecycle of Yersinia Pestis?

Y. Pestis Cycle
Flea bites an infected rat
Y. pestis makes coagulase so the blood clots and the
flea cant swallow
Flea bites a human and spits up the clot with all the Y.
pestis in it
Y. pestis enters skin and travels via lymphatics to LN
Y. pestis is phagocytosed and replicates
INTRACELLULARLY and starts making I antigen
Host cell lyses and spills out Y. pestis, which is now
resistant to phagocytosis
What are the 3 different types of plague?

 Bubonic plague
Fever + general symptoms + delirium
BUBO = super painful swollen LN
Necrosis of fingers/toes Black Death

Pneumonic plague
Y. pestis spreads from bubo to lung (via blood)
Form of plague that is super contagious between
people airborne cough/hemoptysis

Septicemia plague
Bacteria are in the blood but there
is no bubo (so its hard to recognize)

Yersinia enterocolitica
Infected via GI tract
Invades intestinal epithelial cells
Invasin, attachment invasion locus, YadA

Epithelium Peyers patches

(both types of Yersinia like to live in LN)

Virulence/pathogenesis
Evade immune system (phagocytosis PLUS
complement): pYV
Invasion proteins
Siderophores

Y. Enterocolitica disease
Fever + RLQ pain (Peyers patches)
appendicitis? No
Fever + diarrhea for up to 3 weeks!
Usually in the winter chitterlings
during holiday parties
Seen in AA babies/kids who get it from the
hands of caregivers who were cooking pork
Blood transmission super bad, 50% die

Pasteurella multocida
Gram negative coccobacilli facultative anaerobes
If its pathogenic it has a capsule (antiphagocytic +
intracellular survival)
20% dog bites, 50% of cat bites, animal licking a
wound (lives in animal tonsils)
Inflammation of wound + lymphadenopathy + wound
discharge +/- fever cellulitis or subQ abscess
Osteomyelitis, arthritis

 No history of animal exposure? worse

disease
Chronic respiratory illness
Meningitis
Sinusitis
Liver abscess
Peritonitis

Francisella tularensis
Small, aerobic, gram negative,
coccobacilli
Catalase positive
Intracellular
Cell wall FA rich
FrancisellA

All have beta lactamase

Francisella tularensis
Francis
Chocolate Rabbit
Thayer-martin,
Chocolate Media
Fatty Acids

Coccobacilli
Small, aerobic
Missouri, Arkansas,
Oklahoma

Francisella tularensis
Requires cysteine
Francisella, Pasteurella,
Legionella
FPL
The -ella's, or the girls
Girls are sissies
Girls really need cyses (kisses)

How is it transmitted?
Insect/tick bite
o Arthropod or insect vectors
Skinning/dressing animal
aerosoles
o Rabbits, hamsters, mice,
squirrels, beavers
o NO human to human
Farmers, vets, hunters, trappers, meat
handlers, lab workers (Men >30)

Where in the body would you find this

organism?
Facultatively Intracellular
Hepatocytes, macrophages, endothelium

How does it spread?

Lymphohematogenously
Multiple organs: liver, spleen, lungs

What type of immunity is most

important?
Cell Mediated
(Though humoral also presents a week later)

Francisella tularensis
Super aggressive and virulent!!!
Only need 10-50 organisms inhaled/ingested to
get sick (ingest 10^8)
Infected Organs
Infiltration by neutrophils, lymphocytes,
macrophages
Focal necrosis in bone marrow, node, lung, liver,
spleen
Granulomas develop and caseate (Looks like TB)

Symptoms
Abrupt fever, chills, anorexia, vomiting, diarrhea,
sore throat, cough
Can relapse/remit for 32 days
Pulse-temperature deficit in 42%

4% die w abx, 33% w/o

Tularemia Types
Ulcerogranular tularemia
Clinically, very Similar to bubonic plague
Plague lacks skin ulcer + less mortality

Pneumonic tularemia
Initial presentation dominated by pulmonary infection

Typhoidal tularemia: GI, Non specific typhoidal illness

Oculoglandular tularemia: through conjunctiva (by
hands or splash).
Unilateral papules/ulceration on conjunctiva
Pre-auricular, submandibular, cervical adenopathy

Glandular tularemia: No skin lesion

Regional lymphadenopathy

Pharyngeal tularemia:
Contaminated food/water OropharynxExudative
pharyngitis w ulcers

Francisella Buzz Words

Ulcerated Papule + Swollen Lymph Node
Farmers, Hunters, Veterinarians, Trappers
Rabbit Fever
Summer, Arkansas, Male with tick bite
(Ulceroglandular tularemia)
Cysteine needed for growth

Legionella pneumophila
Gram negative, aerobic,
non-spore forming
unencapsulated bacilli

Legionella pneumophila
French Legionnaire sitting at a campfire with his silver
helmet and iron sword - hes no sissy
Campfire Charcoal yeast extract
Sissy Cysteine (also, one of the ellas)
Iron Need iron for growth

Sources of Legionella?
River, lakes + Cooling tower aerosoles
Air conditioning systems
Cooling towers
Whirlpools
Growth in shower heads
Mist machines in supermarkets

No person to person transmission

Legionella pneumophila
Chlorine tolerant
Wide range of temperatures
Requires symbiotic microorganism like
amoeba to grow

Pathogenesis

What Type of Immunity?

Risk Factors?
Cell Mediated Immunity
Risks (impaired cilia):
smoke, lung disease
age, immunosuppression

Types of Legionella
Pontiac fever: Acute Flu-like illness, 1-2 days incubation
Headache, muscle aches, fatigue, fever, chills
Pontiac fever strikes suddenly and completely resolves in less
than one week (Without antibiotics)
Attack rate: >90%
Inhalation of endotoxin

Legionnaires' disease: severe pneumonia

Very high fevers (>103) + severe pneumonia + hyponatremia;
(May have diarrhea 25-50%)
Common cause of community acquired pneumonia (3rd)
Uncommon hematogenous spread extrapulmonary

Legionella Buzz Words

Pneumonia Outbreak with Hyponatremia

Pontiac Fever
Charcoal Yeast Extract
Cooling Towers
Mip protein

GOOD LUCK!