ENTEROBAKTER

Enterobacteriaceae
Small Gram-negative rods Most motile with peritrichous flagella
Shigella and Klebsiella are nonmotile

Oxidase-negative facultative anaerobes Reduce nitrate Ferment glucose and other carbohydrates Many genera
Escherichia, Salmonella, Shigella, Klebsiella, Proteus, Enterobacter, Yersinia, etc.

Some strains opportunistic pathogens Some strains true pathogens

Salmonella, Shigella, Yersinia, some strains of E. coli

Enterobacteriaceae
Family Enterobacteriaceae often referred to as enterics Four major features:

All ferment glucose (dextrose) All reduce nitrates to nitrites All are oxidase negative All except Klebsiella, Shigella and Yersinia

are motile

Virulence and Antigenic Factors of Enterobacteriaceae

Ability to colonize, adhere, produce various toxins and invade tissues Some possess plasmids that may mediate resistance to antibiotics Many enterics possess antigens that can be used to identify groups
O antigen somatic, heat-stable antigen located in

the cell wall H antigen flagellar, heat labile antigen K antigen capsular, heat-labile antigen

Clinical Significance of Enterics

Enterics are ubiquitous in nature Except for few, most are present in the intestinal tract of animals and humans as commensal flora; therefore, they are sometimes call fecal coliforms Some live in water, soil and sewage

Clinical Significance of Enterics (contd)

Based on clinical infections produced, enterics are divided into two categories:
Opportunistic pathogens normally part of

the usual intestinal flora that may produce infection outside the intestine Primary intestinal pathogens Salmonella, Shigella, and Yersinia sp.

Gram-Positive Cell Wall

GramNegative Cell Wall

Antigenic Structure of Enterobacteriaceae

S. typhi

O antigen side chain

(Fimbriae)

Structure of Lipopolysaccharide

Structure of Lipid A

Hydrophobic

Lipid A is endotoxic component

EXOTOXIN

ENDOTOXIN

1. Released from the cell before 1. Integral part of cell wall or after lysis

2. Protein
3. Heat labile 5. Toxoids can be produced 6. Specific in effect on host 7. Produced by gram-positive and gram-negative organisms

2. Endotoxin is LPS; Lipid A is toxic component 3. Heat stable 5. Toxoids cannot be produced 6. Many effects on host 7. Produced by gram-negative organisms only

Diversity of Activities Associated with LPS

Sites of Infections with Members of the Enterobacteriaceae

Incidence of Enterobacteriaceae Associated with Bacteremia

Enterobacter species
Isolated from wounds, urine, blood and CSF Major characteristics

Colonies resemble Motile

Klebsiella

MR negative; VP positive

Enterobacter are gram-negative bacteria Found in the environment,on human skin, and in our intestinal tract. many are harmless,several species are opportunistic pathogens present in hospital settings. The most common pathogenic species are E. cloacae and E. aerogenes

The urinary and respiratory tracts are the most common sites of enterobacter infection. The lower respiratory tract, Urinary tract, Joint, Skin, Heart, Intra-abdomen, Soft tissue, Bone

Risk factor
Patients are most susceptible to enterobacter infections stay in the hospital, especially the ICU, for extended periods. Patients under the age of 2 and over the age of 65 Prior use of antimicrobial agents. Underlying diseases. Ulcers of the upper gastrointestinal tract. Presence of intravenous catheters. Serious conditions such as burns or mechanical ventilation.

Immunosuppression.

spread through contact with the bacteria on patients, contaminated surfaces, and medical equipment

Enterobacter cloacae infections are seen commonly in burn victims, immunocompromised patients, and patients with malignancy The urinary and pulmonary systems are the organ systems most commonly colonized in these patients.

Enterobacter sakazakii meningitis and death associated with powdered infant formula

Clinical Characteristics
Pathogenic organism

affinity for nervous system

Complications serious

necrotizing enterocolitis sepsis meningitis cerebral abscesses, cysts or infarction

Outcome poor impaired neurologic outcome expected fatality rate 40 - 80%

Lai KK. Medicine 2001;80:113-22

Case Description

Male patient admitted to neonatal intensive care unit (NICU) April 2001
gestational age 33.5 weeks, C-section delivery

APGAR scores 4 and 7, birthweight 1,270

grams

day 3: started on enteric feeding

powdered

formula breast milk

day 11: sepsis and neurologic symptoms

Case Description

Lumbar puncture consistent with meningitis

white cells and red cells present, high protein,

low glucose cerebrospinal fluid culture grew E. sakazakii

Treated with ampicillin and cefotaxime Infant pulseless, resuscitated on pressors day 20: expired after withdrawal of support due to severe neurologic disease

Laboratory Diagnosis of Enterics

Identification (contd)
All enterics are Oxidase negative Ferment glucose Reduce nitrates to nitrites

Laboratory Diagnosis of Enterics (contd)

Common Biochemical Tests

Lactose fermentation and utilization of

carbohydrates Triple Sugar Iron (TSI) ONPG Glucose metabolism

Methyl

red Voges-Proskauer

Laboratory Diagnosis of Enterics (contd)

Common Biochemical Tests (contd)

Miscellaneous Reactions Indole Citrate utilization Urease production Motility Phenylalanine deaminase Decarboxylase tests

Enterobacter species