1. Aerobic gram-negative nonenteric bacilli including Yersinia, Pasteurella, and Haemophilus 2010271079 주현영 ( 자 료수집, 퀴즈, 발표 ) 2011274040 성미영 ( 자 료수집, 퀴즈, 발표 ) 2011274034 손주영 ( 자료수집 및 정리, PPT ) 2011274025 김민준 ( 자료수집, 자료정리 )

2. CONTENTS

5. Aerobic Gram negative Bacilli - Non-spore forming bacteria - Wide range of habitats - Highly diverse in metabolism and pathogenicity - complex cell wall : lipopolysaccharide(LPS) --> endotoxin

8. Pseudomonas

9. 01 Pseudomonas - Habit Soil, Seawater (free-living bacteria) Plants, animals, contaminants in home, clinical setting - Shape A single-polar flagellum, gram (-) rods - Produce water soluble pigment  change medium color

10. - Characteristic - Oxidase (+) & Catalase (+) - No ferment carbohydrate  oxidation metabolism (anaerobic condition  salt such as nitrate) - Important decomposers and bioremediators 01 Pseudomonas

11. 02 Pseudomonas aeruginosa - Habit : soil, water and intestinal resident (about 10% of normal people) - Resistance in soaps, dyes, disinfectants, drugs and drying (frequent contaminant) - Opportunistic (invade weakened host defenses) - Virulence factor  exotoxin  phagocytosis-resistance slime layer  endotoxic shock

12. 02 Pseudomonas aeruginosa Characteristics of infection Blue-green or yellow pigment (pyocyanin) - Grapelike odor - Exudate

13. 03 Pseudomonas aeruginosa as pathoggen as pathoggen - Community infection - Nosocomial infection Characteristic of infection (grape-like odor : blue pus)

14. 04 Treatment of Pseudomonas aeruginosa Pseudomonas aeruginosa Multidrug resistance - Cephalosporins - Aminoglycosides - Carbenicillin - Polymixin - quinolones, - Monobactams

16. - Genera * Burkholderia, Acinetobacter, Stenotrophomonas - Similar to pseudomonads - Living in soil, water, and related environments - Oxidase (+) - Opportunistic infection - Culture in blood agar and MacConkey agar

17. 01 Burkholderia cepacia - Isolated from moist environment - Toxic substance biodegradation - Resistance in antimicrobic drugs - Co-infection with Pseudomonas → severe respiratory compromise - Opportunistic infection

18. 02 Burkholderia pseudomallei - Resides in soil and water of tropical climate - Produce both exotoxins and endotoxins -melioidoses : Prevalent in Southeast Asia, Africa, India, Middle East -symptoms : wound infection – skin nodules along with symtoms of fever and muscle aches lung infection - bronchitis, pneumonia -Chronic infection : septicemia, endotoxic shock, abscesses in liver, brain.

19. 03 Acinetobacter baumanii - soil and water - resistant to environment - nosocomial & community-acquired infections - multidrug-resistant(MDR) strains (combination of carbapenem, colistin, polymyxin B, ampicillin) - control : isolation procedure, environmental disinfection 등

20. 04 Stenotrophomonas maltophilia - Living in water, soil associated with plant root - Contaminant - Formation of biofilm - High resistance to multidrugs - Effective in cephalosporin, Tetracycline, fluoroquinolone, newer penicillin

22. Brucella

23. 01 Brucella -Synonyms → uldulant fever → malta fever → Bang disease - Gram-negative - Coccobacilli - 2 species → Brucella abortus (cattle) → Brucella suis (pig)

24. 02 Brucellosis - Animal brucellosks : cause abortion - Human brucellosks : cause sever febrile illness but not abortion - Human infection enters through damaged skin or mucous membranes of the digestive tract, respiratory tract → infected macrophages → transport into the bloodstream → focal lesion → fluctuating pattern of fever

25. 03 diagnosis, treatment of Brucellosis Diagnosis patient’s history serological test ( Agglutination titer test ) blood cultures Newer genetic test Treatment Combination of tetracycline and rifampin or streptomycin

26. Francisella tularensis

27. 01 Francisella tularensis -Gram-negative -coccobacilli - Similar to Yersinia pestis - Rabbit fever

28. 02 Infection of Tularemia - contact with infected animals, water and dust or bites by vectors - not communicated from human to human

29. 03 Symptoms of Tularemia - Headache, fever, chills, malaise - Ulcerative skin lesion - Swollen lymph glands - Sore throat - Intestinal disruption

30. 04 treatment, prevention of Tularemia Treatment gentamicin, tetracycline Prevention Live attenuated vaccine Protective glove, mask, eyewear

32. Bordetella

33. 01 Bordetella pertussis -Gram-negative -Encapsuled coccobacillus - Responsible for pertussis (whooping cough) - Direct contact with inhaled droplets of aerosols

34. 02 Virulence factor of Pertussis (whooping cough) of Pertussis (whooping cough) - receptors : recognize ciliated respiratory epithelial cells - toxin : destroy and dislodge ciliated cells → the loss of the ciliary mechanism → build up of mucus and blockage of the airways

35. 03 treatment, prevention of Pertussis Treatment erythromycin azithromycin septra Prevention Vaccine (DTap) Acellular vaccine contains toxoid and other Ags Boostrix diphtheria, tetanus, pertussis

36. Legionella

37. 01 Legionella - gram-negative motile rods - Catalase( + ), oxidase (+) - Fastidious nutrient requirements (BCYE →pH about 6.9) - Ability to survive and persist in natural habitats

38. 02 Infection of Legionella - D istributed in aqueous habitats - Tap water, cooling towers, spas, pond etc. → living intracellular in free-living ameba - Transmitted by aerosol from air conditioner, cooling tower, etc. - Can be carried for long distances - Not communicable from person to person

39. 03 Symptoms of Legionella -Legionnaires disease → Fever(41 ℃ ), cough, diarrhea, abdominal pain → Lung consolidation, impaired respiration & organ (fatality rate : 3~30%) -Pontiac fever → Fever(41 ℃ ), cough, diarrhea, abdominal pain → Does not lead to pneumonia and rarely cause death

40. 04 Diagnosis, treatment of Legionella Treatment Erythromycin with rifampin Diagnosis Fluorescent antibody staining Cultivation on charcoal yeast extract (CYE) agar, DNA probes Symptom&patient’s history

41. PseudomonasBrucellaFrancisellaBordetellaLegionella 기회감염균동물병원균 ( 가축 ) 동물병원균 ( 야생토끼 ) 인간감염균 - 녹농균 -flagellum 有 - 산화작용 -free-living -p.aeruginosa -Brucellosis - 유산유발 ( 동물 ) - 파상열발생 - 동물접촉주의 ( 장갑, 옷, 안경 ) -Tularemia - 사람간감염 X - 피부, 림프선 증상나타남 -Whooping cough - 발병의근원은 receptor&toxin -Legionellosis - 폐렴유발 - 물에잘삼 Aerobic Gram-negative Nonenteric Bacilli

43. - The enteric Yersinia - Y. enterocolitica, - Y. pseudotuberculosis - Noneneric Yersinia - Y. pestis Pasteurella spp. - P. multocida - Haemophilus spp. - H. influenzae - H. aegyptius - H. parainfluenzae

45. 01 Enteric Yersinia - Y.enterocolitica & Y.pseudotuberculosis intestinal inhabitants of wild and domestic animals → enteric infections in humans

46. 02 Yersinia enterocolitica - Healthy and sick farm animals, fish, fruits & vegetables, drinking water → invade the small intestinal mucosa → lymphatics → intracellularly in phagocytes → inflammantion of the ileum & mesenteric lymph nodes → severe abdominal pain (mimics appendicitis) 03 Yersinia pseudotuberculosis - Similar to Y.enterocolitica - Lymph node inflammation

47. 04 Nonenteric Yersinia pestis

48. - Gram-negative rods - Bipolar staining -Capsules (+) - Facultative anaerobes -Spore (-) -flagella (–) - Pandemics of plague - Zoonotic disease 04 Nonenteric Yersinia pestis

49. - Capsular and envelope proteins → protect against phagocytosis → foster intracellular growth - Coagulase : clots blood → obstructing blood vessels in human → clogging the esophagus in fleas - Endotoxin & intracellular murine toxin 05 Virulence factors of nonenteric Yersinia pestis of nonenteric Yersinia pestis

50. Plague bacillus : naturally in many animal hosts Endemically : Africa, South America, the Mideast, Asia, the former USSR, India Attributed to increased populations of rats, flea vectors No human to human transmission since 1924 Humans can develop plague : Through contact with wild animals (Sylvatic plague) : Domestic or semidomestic animals, or infected humans (Urban plague) 06 The complex epidemiology

52. 07 The infection cycle -Endemic reservoir hosts → harbor the organism but do not develop the disease -Amplifying hosts → become infected, massive die-offs during epidemics spread the disease to other mammals → sources of human plague -Flea vector - tiny, blood sucking insects, the bacilli multiply in its gut - The esophagus becomes blocked → unable to feed → ravenous flea jumps from animal to animal → regurgitated infectious material into the bite wound - by inhaling droplet in infected human

53. Plague infectious dose : 3 to 50 cells Bubonic plague Septicemic plague Pneumonic plague 08 Pathology of plague

54. - The plague bacillus multiplies in the bite → necrosis & swelling of the local lymph nodes (bubo) - Typically in the groin and less often in the axilla - 2~8days after fever, chills, headache, nausea, weakness, tenderness of bubo. 09 Bubonic plague

55. -Bubonic plague progress to massive bacterial growth in the blood - Disseminated intravascular coagulation(DIC), subcutaneous hemorrhage, purpura → necrosis & gangrene → darkening of the skin “black death” 10 Septicemic plague black death

56. - Localized to the lungs - Highly contagious through sputum, aerosols 11 Pneumonic plague

57. 12 Diagnosis, treatment, prevention of plague of plague Treatment Streptomycin Tetracycline Chloramphenicol Prevention Killed vaccine (effective only for a few month) Attenuated vaccine (more effective but also has more side effects) Diagnosis The patient’s history Death as quickly as 2 to 4 days after the appearance of symptoms Culture of bubo aspirate

58. 04 Nonenteric Yersinia pestis

59. 13 일 사이언스 데일리와 BBC 등의 보도에 따르면 독일 · 캐나다 연구팀은 영국 런던시내 흑사병 사망자 매몰지 에서 발굴된 유골의 치아 조직으로부터 최근 ‘ 여시니아 페스티스 (Yersinia pestis)’ 세균을 얻어 내 전체 유전자, 즉 지놈 (Genome) 을 분석했다. 사망자 매몰지는 현재 영국 조폐국 건물 지하에 위치하고 있다. 흑사병 병원균은 들쥐에 붙어 사는 쥐벼룩에 의해 옮겨지는 것으로 알려져 있다. 연구팀이 여니시아균의 DNA 를 분석한 결과,14 세기의 병원균이 현재 유행하는 선 ( 線 ) 페스트균과 유전적으로 큰 차이가 없다는 사실을 확인했다. 연구팀은 특히 밝혀낸 균이 요즘도 매년 전 세계에서 2000 여 명의 목숨을 앗아가는 모든 페스트균의 조상이란 사실도 확인했다. 현대 페스트균과 유전적으로 큰 차이가 없는데도 그토록 창궐했던 것과 관련해 연구팀은 “ 병원균의 지놈이 미 미한 차이를 보이더라도 치명적일 수 있다 ” 고 설명했다. 연구팀은 또 당시 흑사병이 맹위를 떨친 것은 병원균 자체의 맹독성 외에 ▶흑사병균과 함께 유행한 다른 병원균과 ▶중세 유럽에서 나타난 ‘ 소빙하기 ’ 등 다양한 요 인이 작용했을 수 있다고 덧붙였다. 특이한 점은 당시 병원균에서 확인된 DNA 염기서열 중 일부가 올 5 월 독일 과 프랑스에서 50 여 명의 목숨을 앗아갔던 병원성 대장균에서도 나타났다는 것이다. 연구팀의 일원인 캐나다 맥매스터대학의 유전학자 핸드릭 포이너는 “ 당시 사람들이 새로 등장한 병원균에 대해 면역학적으로 대비가 되지 않은 상태인 데다 영양상태도 나빴기 때문에 치사율이 높았을 것으로 보인다 ” 고 말 했다. ‘7500 만 명 목숨 앗은 ‘ 흑사병 ’ 세균 지금도 떠돈다.’, 강찬수 기자

61. - Oxidase (+) Nonenteric Pathogens - Gram-negative rods - Normal flora in animals - Facultative anaerobes - Optimal temperature : 33 ~ 37 ℃ - Motility (-) - Bipolar staining - Grow well on blood or chocolate agar, but not MacConkey agar - Virulent factor : endotoxin (LPS), capsule - Most common in human disease : Pasteurella multocida 01 Pasteurella

62. - Normal flora in animals - Zoonotic infection - Opportunistic infections - Poultry & wild fowl : cholera-like outbreaks - Cattle : outbreaks of hemorrhagic septicemia or pneumonia “shipping fever” - Cats & dogs : nasopharynx, tonsils 02 Pasteurella multocida

63. - Animal bites or scratches → local abscess → immunocompromised patients : septicemic complication (Central nerve system, heart) -Treatment Penicillin, Tetracycline, Cepahlosporin 03 Infection of Pasteurella multocida

64. Haemophilus H. influenzae, H. aegyptius, H. ducreyi, H. parainfluenzae, H. aphrophilus

65. - Tiny, gram-negative coccoid bacilli - Filamentous, spherical bodies - Fastidious & sensitive to dry, temperature, disinfectants -Not grow on blood agar, require for Blood factor * factor X: necessary component of cytochromes, caralase, peroxidase * factor V: important coenzyme - Chocolate agar, Filed medium 04 Haemophilus - Blood loving Bacilli

66. - Nonvirulent species : normal colonist of the upper respiratory tract or vagina - Virulent species H. influenzae H. aegyptius ( conjunctivitis ) H. ducreyi ( chancroid ) H. parainfluenzae ( childhood miningitis ), H. aphrophilus 05 Nonvirulent & Virulent

67. - Isolated from patients with ‘flu’, but the causative agent → influenza virus -Acute bacterial meningitis : By the ‘b’ serotype, children ( 3 months ~ 5 years ) 06 Haemophilus influenzae

68. - Haemophilus meningitis → Not associated with epidemics, but sporadic cases or cluster in daycare & family settings → Very similar symptom to meningococcal meningitis - Haemophilus infections → Transmitted by close contact, nose & throat discharges → Healthy adult carriers : reservoirs of the bacillus → Untreated cases : fatality rate is 90%

69. - Epiglottitis → In older children & young adults → Immediate intubation or tracheostomy - Otitis media, Sinusitis, Pneumonia, Bronchitis Treatment chloramphenicol + ampicillin rifampin prophylaxis combination with DTaP Prevent vaccination - subunit vaccine ( Hib ) → based on type ‘b’ polysaccharide

70. 07 Haemophilus aegyptius - Koch - Weeks bacillus - Diseases : acute communicable ‘conjunctivitis’(pinkeye) - In children, by contaminated fingers & shared personal items, gnats & flies - Treatment : antibiotic eyedrops

71. 08 Haemophilus ducreyi - Diseases : chancroid ( soft chancre ) : STD -In the tropics & subtropics, mostly males -direct contact with infected lesions unclean personal habits. - Treatment : cotrimoxazole 09 Haemophilus parainfluenzae & Haemophilus aphrophilus & Haemophilus aphrophilus - Normal oral & nasopharyngeal flora - Diseases : infective endocarditis in adults (underlying congenital or rheumatic heart disease) - Periodontal disease, oral injury

74. 1. I t is free living bacteria 2. I t produces oxidase and catalase 3. I t has bipolar flagellum 4. I t produces green, brown, red or yellow pigment 5. I t is useful in cleaning up oil spills and pesticide 01 Which is NOT characteristic of the pseudomonads?

75. 1.Legionella 2. B rucella 3. L isteria 4. B ordetella 5. P sudomonas 02 Which of the following are not gram negative bacteria?

76. 1. I t is Gram negative bacilli 2. Y. psudotuberculosis is Enterobacter 3. I t has bipolar flagellum 4. It is facultative anaerobes 03 Which is different from Yersinia?

77. 1. α-ketoglutaric acid 2.Hemin 3.Pyridium nuclease 4. Nicotinamide ademine dinucleotide 5. Hemin 04 What is V factor nessecery to grow Heamopillus?

78. 최신 진단미생물학 / 서흥출판사 / 정윤섭 외 6 명 Microbiology / Macgrawhill / Kathleen Park Talaro 진단미생물학 / 현문사 / 김양호 외 5 명 병원미생물학 / 청구문화사 / 김영권 중앙일보 / 2010.10.14 REFERENCE

79. THANK YOU :D