1. Enterobacteriaceae

2. Enterobacteriaceae
The most important bacterial family in human medicine
Well-defined diseases with typical clinical symptoms:
Typhoid fever, dysentery and plague
Nosocomial infections:
Urinary tract infections, pneumonias, wound infections and sepsis
The most important bacterial family in human medicine is the Enterobacteriaceae.
This family includes genera and species that cause well-defined diseases with typical clinical symptoms (typhoid fever, dysentery, plague) as well as many opportunists that cause mainly nosocomial infections (urinary tract infections, pneumonias, wound infections, sepsis). Enterobacteriaceae are Gram-negative, usually motile, facultatively anaerobic rod bacteria.
The high levels of metabolic activity observed in them are made use of in identification procedures. The species are subdivided into epidemiologically

3. Definition and significance
41 genera with hundreds of species
Gram-negative, facultatively anaerobic rod
Natural habitat: intestinal tract of humans and animals

4. The Most Important Genera/Species/Vars of Enterobacteriaceae and the Corresponding Clinical Pictures

6. Virulence and pathogenicity
The most important pathogenicity factors:
Colonizing factors
Invasins
Endotoxin
Exotoxins
Enterobacteriaceae are the most significant contributors to intestinal infections
The most important pathogenicity factors of Enterobacteriaceae are colonizing factors, invasins, endotoxin, and various exotoxins. Enterobacteriaceae are the most significant contributors to intestinal infections, which are among the most frequent diseases of all among the developing world populace.

7. Identification of Enterobacteriaceae
Gram-negative rod
Usually motile (with few exceptions)
Facultative anaerobes
Grow on simple nutrient media
Oxidase test negative
Ferment glucose with acid or acid and gas

8. Sero-typing based on antigenic structure
O antigens: Somatic antigens (polysaccharide)
H antigens: Flagellar antigens (protein)
K antigens: Capsular antigens (carbohydrate)
e.g., serovar O18:K1:H7
O antigens. Specific polysaccharide chains in the lipopolysaccharide complex of the outer membrane.
H antigens. Flagellar antigens consisting of protein.
K antigens. Linear polymers of the outer membrane built up of a repeated series of carbohydrate units (sometimes proteins as well). They can cover the cell densely and render them O inagglutinable.
F antigens. Antigens of protein attachment fimbriae.

9. Escherichia coli Klebsiella and Proteus

10. Escherichia coli

11. Escherichia coli on ChromID CPS agar

12. Natural habitat Intestinal tract of humans and animals
indicator organism for fecal contamination of water and foods
The natural habitat of E. coli is the intestinal tract of humans and animals.
It is therefore considered an indicator organism for fecal contamination of
water and foods.

13. Infections Extraintestinal infections
Intestinal infections (Diarrhoeal diseases)
The natural habitat of E. coli is the intestinal tract of humans and animals.
It is therefore considered an indicator organism for fecal contamination of
water and foods.

14. Extraintestinal infections
Urinary tract infections
Wound infections
Peritonitis
Cholecystitis
Appendicitis
Sepsis and endotoxin induced shock
Neonatal meningitis
E. coli is the most frequent causative pathogen in human
bacterial infections. Extraintestinal infections include urinary tract infections,
which occur when the tract is obstructed or spontaneously caused
by the pathovar UPEC. The most important other coli infections are cholecystitis,
appendicitis, peritonitis, postoperative wound infections, and sepsis.

15. Diarrheagenic pathovars
Enteropathogenic E. coli (EPEC)
Enterotoxigenic E. coli (ETEC)
Enteroinvasive E. coli (EIEC)
Enterohaemorrhagic E. Coli (EHEC)
Enteroaggressive E. coli (EaggEC)
Intestinal infections are caused by the pathovars EPEC, ETEC, EIEC, EHEC,
and EAggEC. EPEC and EAggEC frequently cause diarrhea in infants. ETEC
produce enterotoxins that cause a choleralike clinical picture. EIEC cause a
dysenterylike infection of the large intestine. EHEC produce verocytotoxins
and cause a hemorrhagic colitis as well as the rare hemolytic-uremic syndrome.
E. coli bacteria infections are diagnosed by means of pathogen identification.

16. EPEC Frequently cause diarrhea in infants
Vomiting, fever and prolonged diarrhoea
Infants mainly
Many serotypes

17. ETEC Enterotoxins that cause watery diarrhoea similar to cholera
Infants and adults
Traveler diarrhea
Many serotypes
Plasmid mediated toxin (HS, HL)

18. EIEC
Cause a dysentery like infection of the large intestine (similar to shigellosis)
Fever and colitis
Many serotypes

19. EHEC
Produce verocytotoxins and cause a hemorrhagic colitis (damage to vascular endothelia )
Causes life-threatening haemorrhagic diarrhoea
All ages

20. EHEC No pus cells and no fever
It can progress to Haemolytic Uremic Syndrome → Renal failure
O157:H7 or verocytotoxin-producing E. coli
Contaminated meat products, unpasteurized milk and diary products

21. EaggEC
Chronic watery diarrhoea
Mainly in children

24. Klebsiella species

25. Klebsiella species

26. Klebsiella pneumoniae
Four subspecies:
K.p. pneumoniae
K.p. aerogenes
K.p. ozaenae
K.p. rinhoscleromatis

27. Infections caused by Klebsiella species
UTI
Wound infections
Chest infections

28. Proteus species

29. Proteus species on Blood Agar

30. Medically important Proteus species
P. mirabilis
UTI
Wound infection
Septiceamia
Occasionally meningitis and chest infections
P. vulgaris
UTI and wound infections
Alkaline reaction
Common cause of male UTI specially those with catheter or cytoscopy

31. Other enterobacteria

32. Other enterobacteria Enterobacter Citrobacter Serratia
Opportunistic pathogens:
UTI
Wound infections
Septiceamia
Pulmonary infections

33. Laboratory diagnosis Specimens: Direct examination:
Urine, pus, faeces, CSF, blood, sputum
Direct examination:
Gram –ve bacilli
Few capsulated
Culture aerobically at 36-37° C:
Blood agar
MacConkey agar
CLED
XLD and DCA

34. UTI CFU/ml Midstream urine Bacterial count
≥105/ml indicate an infection
104/ml doubtful significance
≤103/ml indicate a contamination

35. MacConkey agar showing lactose and non-lactose fermenting colonies

36. Escherichia coli (Gram negative)

37. Oxidase test