Opportunistic Enterobacteriaceae OPPORTUNISTIC INFECTIONS OF ENTEROBACTERIACEAE GRAM NEGATIVE SEPSIS URINARY TRACT INFECTIONS PNEUMONIA ABDOMINAL.

Opportunistic Enterobacteriaceae

OPPORTUNISTIC INFECTIONS OF ENTEROBACTERIACEAE

GRAM NEGATIVE SEPSIS

URINARY TRACT INFECTIONS

PNEUMONIA

ABDOMINAL SEPSIS

MENINGITIS

SPONTANEOUS BACTERIAL PERITONITIS

ENDOCARDITIS

OPPORTUNISTIC INFECTIONS (cont.)

GRAM NEGATIVE SEPSISLife-threatening Usually nosocomialCommonly caused by E. coli

PATHOGENESIS:

Early Phase (REVERSIBLE)

Decreased arterial resistance; Increased cardiac output

Kinins (protein vasodilators & mediators of inflammation) in plasma due to tissue damage, endotoxin, AG-AB

complexes

Second Phase (REVERSIBLE)

Increased arterial resistance; Decreased cardiac output

Third Phase (IRREVERSIBLE)

Vascular collapse with organ failure

Endotoxin induced DIC, hemorrhage and death

OPPORTUNISTIC INFECTIONS (cont.)

URINARY TRACT INFECTIONSUsually ascending infection, not hematogenous routeGreatest incidence in young & middle-aged femalesIncidence increases with age in malesMost commonly caused by E. coliDiagnosis by microscopic & cultural exam of urineObtain urine by catheter through urethra into bladder, clean

catch midstream (CCMS) or suprapubic tap

PNEUMONIA Nosocomial; Spread by personnel and equipmentFrequently caused by K. pneumoniae Often in middle-aged males who abuse alcoholDifficult to diagnose due to commensals in sputum

OPPORTUNISTIC INFECTIONS (cont.)

ABDOMINAL SEPSISCaused by flora of the GI tractInfections usually polymicrobial

MENINGITISUsually nosocomialFrequently caused by E. coliDiagnosis by microscopic & cultural exam of CSF

OPPORTUNISTIC INFECTIONS (cont.)

SPONTANEOUS BACTERIAL PERITONITISUsually in patients with liver ailmentsCommonly caused by E. coli, but also anaerobes

& Gram-positive cocci (S. pneumoniae)

ENDOCARDITISVascular endocardial surface inflammationMostly caused by Gram-positive cocci, but 1-3%

caused by aerobic Gram-negative rodsDiagnosis by blood cultureDifficult to treat; Treatment is of long duration

Common Virulence FactorsEndotoxinCapsuleAntigenic phase variationSequestration of growth factorsResistance to serum killingAntimicrobial resistance

Factors Associated with Specific PathogensExotoxin productionExpression of adhesion factorsIntracellular survival and multiplication

Virulence Factors Associated with Enterobacteriaceae

Fever Leukopenia (reduced # of WBCs) (<5000/mm3) followed by leukocytosis (increased # of

WBCs)(>10-12,000/mm3) Activation of complement Thrombocytopenia (reduced # of platelets) DIC (Disseminated intravascular coagulation) Decreased peripheral circulation and perfusion

(blood flow) to major organs Shock Death

Endotoxin-Mediated Toxicity

See Handout on Enterobacteriaceae General Information

Summary of Escherichia coli

Infections

Summary of Escherichia coli Infections (cont.)

Gastroenteritis Caused by E. coli

Specialized Virulence Factors Associated with E. coli

EAEC UPEC

EPEC

ETEC Type 1 pili

UPEC

UPEC

EIEC

ETEC

ETEC

EHEC

UPEC

Fimbriated Bacterial Cell

F = Flagellum

Note: All other appendages are fimbriae (a.k.a., pili)

Afimbriated Bacterial Cells

Nonadherent Afimbriated

Bacterial Cells and Buccal Cells

Adherent Fimbriated

Bacterial Cells and Buccal Cells

Fimbriated Bacterial Cells

MICROBIALPATHOGEN ADHESIN RECEPTOR

Staphylococcus aureus LLiippootteeiicchhooiicc aacciidd UnknownStaphylococcus spp. SSlliimmee llaayyeerr UnknownGroup A Streptococcus LLTTAA--MM pprrootteeiinn ccoommpplleexx FFiibbrroonneeccttiinn

Streptococcus pneumoniae Protein N-acetylhexosamine-galEscherichia coli Type 1 ffiimmbbrriiaaee

CFA 1 fimbriaeP fimbriae

D-MMaannnnoosseeGM ggaanngglliioossiiddeeP blood grp glycolipid

Other Enterobacteriaceae Type 1 fimbriae D-MannoseNeisseria gonorrhoeae Fimbriae GD1 gangliosideTreponema pallidum P1, P2, P3 FibronectinChlamydia spp. Cell surface lectin N-acetylglucosamineMycoplasma pneumoniae Protein P1 Sialic acidVibrio cholerae Type 4 pili Fucose and mannose

Heparin-binding epidermal growth factor on heart & nerve surfaces

(ETEC)

(EHEC)

REVIEW

OPPORTUNISTIC INFECTIONS OF ENTEROBACTERIACEAE

GRAM NEGATIVE SEPSIS

URINARY TRACT INFECTIONS

PNEUMONIA

ABDOMINAL SEPSIS

MENINGITIS

SPONTANEOUS BACTERIAL PERITONITIS

ENDOCARDITIS REVIEW

Common Virulence FactorsEndotoxinCapsuleAntigenic phase variationSequestration of growth factorsResistance to serum killingAntimicrobial resistance

Factors Associated with Specific PathogensExotoxin productionExpression of adhesion factorsIntracellular survival and multiplication

Virulence Factors Associated with Enterobacteriaceae

REVIEW

REVIEW

See Handout on Enterobacteriaceae General Information

Fever Leukopenia (reduced # of WBCs) (<5000/mm3) followed by leukocytosis (increased # of

WBCs)(>10-12,000/mm3) Activation of complement Thrombocytopenia (reduced # of platelets) DIC (Disseminated intravascular coagulation) Decreased peripheral circulation and perfusion

(blood flow) to major organs Shock Death

Endotoxin-Mediated Toxicity

REVIEW

Summary of Escherichia coli

Infections

REVIEW

Summary of Escherichia coli Infections (cont.)

REVIEW

Gastroenteritis Caused by E. coli

REVIEW

Fimbriated Bacterial Cell

F = Flagellum

Note: All other appendages are fimbriae (a.k.a., pili)

REVIEW

Afimbriated Bacterial Cells

Nonadherent Afimbriated

Bacterial Cells and Buccal Cells

REVIEW

Adherent Fimbriated

Bacterial Cells and Buccal Cells

Fimbriated Bacterial Cells

REVIEW

MICROBIALPATHOGEN ADHESIN RECEPTOR

Staphylococcus aureus LLiippootteeiicchhooiicc aacciidd UnknownStaphylococcus spp. SSlliimmee llaayyeerr UnknownGroup A Streptococcus LLTTAA--MM pprrootteeiinn ccoommpplleexx FFiibbrroonneeccttiinn

Streptococcus pneumoniae Protein N-acetylhexosamine-galEscherichia coli Type 1 ffiimmbbrriiaaee

CFA 1 fimbriaeP fimbriae

D-MMaannnnoosseeGM ggaanngglliioossiiddeeP blood grp glycolipid

Other Enterobacteriaceae Type 1 fimbriae D-MannoseNeisseria gonorrhoeae Fimbriae GD1 gangliosideTreponema pallidum P1, P2, P3 FibronectinChlamydia spp. Cell surface lectin N-acetylglucosamineMycoplasma pneumoniae Protein P1 Sialic acidVibrio cholerae Type 4 pili Fucose and mannose

REVIEW

Heparin-binding epidermal growth factor on heart & nerve surfaces

(ETEC)

(EHEC)

REVIEW