MICR

PSEUDOMONAS
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Pseudomonas
- 150 species, saprophytic
- >25 species associated with humans
- Gm (-), aerobic bacilli, NLF
- 0.5 to 0.8μm x 1.5 to 3μm

- Motility by a single polar flagellum

- Distinguished by biochemical and DNA hybridization tests

BIOCHEMICAL
COLONIZATION/ CLINICAL MANAGEMENT/
PATHOGENESIS/ VIRULENCE PROPERTIES/
BACTERIA EPIDEMIOLOGY INVASION/ MANIFESTATION/DISEAS TREATMENT/
FACTORS LAB
DISSEMINATION ES PREVENTION
DIAGNOSIS
A. Cell Envelope A. Growth A. Colonization Clinical Manifestations Adhesins • Grows well on Treatment
3 Layers Requirements - Fimbriae  adhere to - disease is rare in - fimbriae (N- methyl- most lab • Combination
1. Inner or - Very simple epithelial cells of URT  healthy individuals only phenylalaninepili) media o Anti
cytoplasmic nutritional adhesions bind to causes chronic otitis - polysaccharide capsule (glycocalyx) o NFL pseudomon
membrane requirements specific galactose or externa - alginate slime (biofilm) o Oxidase al Penicillin
2. Peptidoglycan - Grow in distilled mannose or sialic acid - disease most often o Beta – +
layer water receptors on epithelial occurs in people with Invasins hemolytic Aminoglyco
3. Outer membrane - Organic growth cells natural immunologic - elastase o Characteris side
o Phospholipid factors not required deficiency - alkaline protease
- Optimum
- Colonization requires
immunosuppressive - hemolysins
tic odor
o Protein Prevention
fibrial adherence aided (fruity 
o LPS temperature for therapy burns o phospholipase • Proper
by production of grapes)
B. Colony Types growth is 37° - disease most often o lecithinase isolation
protease enzyme  o Color: blue;
1. natural isolates o able to grow at T occurs in people with - cytotoxin (leucocidin) procedures
degrades fibronectin to o chronic pulmonary fluorescenc
from soil or water as high as 42° - siderophores and siderophore • Use good
expose fimbrial e under UV
small, rough - R to high conc of receptors
disease (CF) uptake systems
o Motile aseptic
colony salts, dyes, weak o IV narcotic use - pyocyanin diffusible pigment technique in
- Receptor on tracheal o Ability to
2. clinical samples – antiseptics, and o Renal dialysis hospital
epithelial cells for grow 42 °C
play a role in many commonly - most common site of Motility / Chemotaxis instruments
pseudomonas pili (sialic
colonization and used antibiotics infection - flagella when in
acid)
virulence - Inhabits soil, water, o urinary tract contact with
- Mucoid strains (produce
a. fried egg vegetation found in o burns Toxins patients
alginate) have
appearance skin, throat, stool - infections take the form - Exoenzyme S • Topical
additional or alternative
 large, of: - Exoenzyme A
adhesion attaches to therapy of
smooth, B. Reservoirs o septicemia, - Lipopolysaccharide
trachebronchial mucin burn
flat edges - Disinfectants, - Exoenzyme S serve as abscesses, corneal wounds with
and respiratory equipment, infections, Antiphagocytic surface properties
an adhesion for antibacterial

...One who does not sacrifice anything cannot achieve anything. ^_^ shar ^_^
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PSEUDOMONAS
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elevated food, sinks, taps, mops glycolipids on memingitis, - capsule, slime layers agents +
b. mucoid - Constantly respiratory cells bronchopneumonia, - LPS surgical
appearance reintroduced into the - Alginate forms the SBE debridement
 alginate hospital environment matrix of Pseudomonas - treatment often fails Defense against serum bactericidal
slime from on fruits, plats biofilm – anchors the with >80% mortality reaction
respiratory vegetables, visitors cells to their - slime layers, capsules
and urinary and patients from environment  protects Diseases - LPS
tract other facilities the bacteria from host 3 Distinct Stages - Protease enzymes
secretions defenses  less S to 1. bacterial attachment
C. Transmission antibiotics than their 2. local invasion Defense against immune responses
o Hands of planktonic counterparts 3. disseminated - capsule, slime layers
personnel - Mucoid strains are most systemic disease - protease enzymes
o Direct patient often isolated from Endocarditis
contact with patients with cystic - infects heart valves of Genetic attributes
contaminated fibrosis IV drug users and - genetic exchange by transduction
reservoir prosthetic heart and conjugation
o Ingestion of B. Invasion valves - inherent drug resistance
contaminated - Depends upon - establishes itself on - R factors and drug R plasmids
foods and water production of the endocardium by
extracellular enzymes direct invasion from Ecologic criteria
and toxins that break the blood stream - adaptability to minimal nutritional
down physical barriers requirements
and damage host Respiratory Infections - metabolic diversity
cells, R to - compromised LRT or - widespread occurrence in a variety
phagocytosis and host systemic defense of habitats
immune defenses mechanism
- Bacterial capsule or o Primary pneumonia Pathogenesis
slime layer effectively  Chronic lung B. Deficiencies in colonization
protects cells form disease and CHF 1. Burns
opsonization by o Bacteremic 2. Lungs: requires compromised
antibodies, pneumonia lung (CF)
complement  Neutropenic C. Alginate (exopolysaccharide)
deposition and cancer patients o Viscous gel around bacteria
phagocyte undergoing o Coating may protect from
engulfment chemotherapy phagocytosis in lung
- 2 Extracellular o LRT colonization of infections
Proteases cystic fibrosis o Produces septicemia in
o Elastase + Alkaline o Patients of neutropenics
protease mucoid strains D. Adhesion
o Cause inactivation o Difficult, if not 1. Pili: type 4
of gamma possible to  Similar:
interferon (IFN) treat  N. gonorrhea

...One who does not sacrifice anything cannot achieve anything. ^_^ shar ^_^
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and tumor necrosis  V. cholerae Tcp pili

factor (TNF) Bacteremia and  Methylated phenylalanine
- 3 Other Soluble Septicemia
Proteins • Bacteria in  1st aa of pilin subunit
o Cytotoxin (MW immunocompromised  Bind preferentially to
25kDa) (leukocidin) patients asialoGM1
 Pore-forming protein • Predisposing factors:  Preceded by removal of
- 2 Hemolysins o Hematologic sialic acid by
o Phospholipase malignancies neuraminidase  better
o Lecithinase o Immunodefici receptor, bind to epithelial
o Act synergistically ency relating cells, not mucin
to break down to AIDS 2. Nonpilus adhesions
lipids and lecithin o Neutropenia, 2 Types
o Contribute to DM, severe - bind to:
invasion through burns  mucin/epithelial cells
their cytotoxic • Accounts for 25% of  mucin only
effects on all hospital acquired
eukaryotic cells gram (-) bacteremias E. Exoenzyme S
- Pigment 1. ADP-ribosylation for
o Pyocyanin Central Nervous System intermediate filaments,
- Impairs normal Infections GTP-binding proteins (Ras)
function of human • Meningitis, abcesses involved in signal
nasal cilia • Invades the CNS from transduction systems
- Disrupts respiratory 2. Exogenously applied ExoS
a contiguous structure
epithelium does not injure tissue
(inner canal,
- Exerts culture cells, no evidence
paranasal sinus)
proinflammatory that ExoS binds host cells,
• Inoculated directly by
effect on internalized; must be
means of head
phagocytes activated by host cell
trauma, surgery or
o Pyoochelin – protein
invasive diagnostic
siderophore 3. Disruption of gene raises
procedure
- Derivative of LD50 for burned mouse
• Spreads from a from 30 cfu to 105 cfu
pyocyanin distant site of
- Produced under low (colonized locally as well as
infection (urinary wild type, did not produce
iron conditions to tract)
sequester iron form septicemia)
the environment for Ear Infections including
4. detection of ExoS in blood
growth of the before septicemia in
otitis externa
pathogen colonization by wild type 
• Predominant bacterial
o Fluorescent pigment may have a role in damage
pathogen in some
- No role to phagocytes which would
cases of external
otherwise spread to blood

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C. Dissemination otitis including 5. ExoS neg strains colonize

- mediated by the “swimmer’s ear” lungs, no extensive damage
same cell • Infrequently found in like WT
associated and the normal ear, but
extracellular often inhabits the F. Exotoxin A
products external auditory 1. same mechanism as DT
responsible for the canal in association  antibodies vs DT do not
localized disease with injury, react with ExoA and
- R to phagocytosis maceration, vice versa, different
and the serum inflammation or receptors
bactericidal simply wet and humid  RXN = ExoA + NAD +
response due to its conditions. EF2 Adp-ribosyl-EF2 +
mucoid capsule and nicotinamide + H
possible LPS Eye Infections 2. internalization/activation of
- Lipid A moiety of • One of the most ExoA
LPS (endotoxin) common cause of  same as DT, regulation
mediates the usual bacterial keratitis y iron
pathologic aspects • Isolated as etiologic 3. present in most clinical
of Gm(-) septicemia agent of neonatal isolates
opthalmia  those without = less
• Colonize the ocular virulent
epithelium by means G. Elastase
of fimbrial attachment o enzyme system which
to sialic acid receptors degrades elastin = maj
• If defenses of the component of lung
H. Phospholipases C (2)
environment are
o hemolytic and nonhemolytic
compromised in any
way, the bacterium I. Leucocidin lethal for WBC, but
can proliferate rapidly nonhemolytic
and through the J. Pigments in 90%
production of enzyme o used a diagnostic feature
elastase, alkaline o involved in iron acquisition
protease and exotoxin o pyocyanin – “pyocyaneus”
A  rapidly to “blue pus”
destructive infection  antibacterial (suppresses
loss of entire eye. growth)
 may aid in colonization
Bone and Joint Infections  damages endothelial
• Direct inoculation of tissue in vitro
the bacteria of the  mediates conversion of
hematogenous spread superoxide to hydroxyl
of the bacteria from
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PSEUDOMONAS
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other primary sites of o pyoverdin – fluoresces in

infection tissue
• Blood borne K. Broadly resistant to
infections: antibiotics
o IV drug users o due to permeability barrier
o In conjunction afforded by its outer
with the urinary membrane LPS
tract or pelvic o tendency to colonize
infections surfaces in a biofilm form
• Particular tropism for makes the cells impervious
the fibrocartilagenous to therapeutic conc
joints of the axial antibiotics
skeleton o may be plasmid mediated
• Causes chronic Toxigenesis
contiguoug - Extracellular protein toxins
osteomyelitis - Exoenzyme S
resulting for the direct o Produce by bacteria growing in
inoculation of bone burned tissue
• Most common o Detected in the blood before
pathogen implicated the bacteria are
in osteochondritis o Impair function of phagocytic
after puncture cells in the blood stream and
wounds of the foot internal organs to prepare for
invasion by P. aeruginosa
Urinary tract Infections - Exotocin A
• Hospital acquired o Exactly same mechanism of
• Related to urinary action as the diphtheria toxin
tract catherization, o Partially identical to diphtheria
instrumentation or toxin but antigenetically
surgery distinct
• 3rd leading cause of o Utilizes a different receptor on
hospital acquired host cells
UTIs- 12% of all o Production regulated by
infections of this type exogenous iron
• Most adherent of o Mediate both local and
common urinary systemic disease
pathogens to bladder o Necrotizing activity at site of
epithelium bacterial colonization cause
more virulent form of
• Can occur via an
pneumonia
ascending or
descending route

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PSEUDOMONAS
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• Can invade the

bloodstream from the
urinary tract – source
of nearly 40% of
Pseudomonas
bacteremias
Gastrointestinal Infections
• Can produce disease
from oropharynx to
the rectum
• Occur primarily in
immunocompromised
individuals implicated
in perirectal
infections, pediatric
diarrhea, typical GE,
NEC (huh?)
• Important portal entry
in P. septicemia

SSTI, wound infections,

pyoderma and dermatitis
• Localized and diffused
• Predisposing factors:
o Breakdown of
the integument
which may
result from
burns, trauma
or dermatitis
o High moisture
conditions
 Ear of
swimmers
 Toe webs of
athletes and
combat
troops
 Perineal
region,
under
diapers of
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PSEUDOMONAS
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infacts
 Skin of
whirlpool
and hot tub
users
 AIDS
 Implicated
in folliculitis
and acne
vulgaris

...One who does not sacrifice anything cannot achieve anything. ^_^ shar ^_^
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