Condensed Notes

Monday, August 18, 2014

8:27 AM

Learning Objectives
- List at least 4 pathogenic Enterobacteriaceae and at least 3 of the defining traits of the group
Features
Gram Non-sporulating
Straight Rods
Facultative Aerobes
Catalase+
Oxidase Glucose fermenters
- Discuss importance of plasmid transfer to group's pathogenic potential
Enterobacteriaceae incorporate foreign DNA frequently
Acquired gut virulence factors
Pili for adhesion
Type 3 secretion systems
Adhesion
Subversion of gut macrophage
Antibiotic resistance
This is why antibiotic resistance testing must be performed for any Enterobacteriaceae infection that requires treatment
- Describe process of antimicrobial sensitivity testing
Liquid culture of pt isolate is spread on large agar plates (NOT streaked for pure colonies; but coated with the culture)
Disks of filter paper soaked in various antibiotics are placed on the plate prior to overnight incubation
Successful plating produces solid lawn of bacteria, which are interrupted by zones of clearing around effective antibiotics
Measurements of clear zones must be compared to a table to determine most effective antibiotic (just because the zone of clearance
is the biggest doesn't necessarily mean that it is the most effective antibiotic)
- Learn importance of pili and T3SS as determinants of virulence for the foodborne Enterobacteriaceae and describe how they
typically fxn in pathogenesis of enterocolitis and possible spread to lymph nodes
Samonella, Yersinia, some E.coli cause watery diarrhea
"YESS"
Shigella, some E-coli cause bloody diarrhea
Neither is likely to need antibiotic treatment
Common pathogenesis is by subversion of immune sampling in M cells in gut
Bacteria use T3SS (type 3 secretion system) to alter gut macrophage
Bacteria survive in altered macrophage --> induce apoptosis --> escape and infect exterior surface of intestine (which is
supposed to be a sterile part)
Some bactra further use altered macrophages as Trojan Horses to reach lymph nodes
Local lymph infection in false appendicitis (caused by Y. enterocolitica)
Systemic lymph node infection in Typhoid fever (by S.typhi)

Microbiology Page 1

- Define hemolytic-uremic syndrome and reactive arthritis and explain relevance of Enterobacteriaceae to each
Hemolytic-uremic syndrome (HUS)
Infection by Shigella or enterohemmorhagic strain of E-coli breaches gut and releases shiga toxin into bloodstream
Shiga toxin sets a cascade --> hemolysis, thrombocytopenia (decrease of platelets in blood), uremia (urea in the blood),
5-10% mortality
Reactive Arthrtis
Autoimmune rxn in patients w/ HLA-B27 (some antigen that is part of a chromosome, present in some people)
Triggered by infection w/ Yersinia, Salmonella, Shigella, Campylobacter, Chlamydia
Defined as Conjunctivtis + Urethritis + Arthritis ("Can't see, Can't Pee, and Can't climb a tree")
Treated w/ NSAID --> usually resolved in 2-5 months
- Explain why non-foodborne opportunistic Enterobacteriaceae pathogens are so difficult to treat
Non-foodborne opportunisitc Enterobacteriaceae ("ICU bugs"
Normal flora gone bad: Klebsiella, Enterobater, Serratia, Proteus, Providencia, Morganella
All require fairly debilitated pt
Klebsiella can cause pneumonia in elderly alcoholics
Serratia can cause endocarditis in IV drug users (inflammation of inner layer of heart)
All can cause catheter-associated UTIs
Proteus/Providencia/Morganella group is particularly associated w/ catheter UTI
All can cause ICU would infections
This is very difficult to treat b/c combination of debilitated pt + antibiotic resistance = mortality rate can be like 40%!
- List best preventative procedures for infection by foodborne and opportunisitc Enterobacteriaceae
Best preventative procedures for foodborne ("YESS") by hygiene (food washing, cooking, handwashing, water treatment)
Best preventative proc for non-foodborne opportunistic by cleanliness (switch catheters & IV lines, scrubdowns of
ICU/equpitment/pts) and minimize hospital stay

Microbiology Page 2