1. Enteric Bacteria Prof. Dr. Asem Shehabi Faculty of Medicine University of Jordan

2. Enteric Bacteria General Characteristics: Gram-ve Bacilli, Facultative Anaerobes, Oxidase-negative.. Part Intestinal Normal Flora.. Humans, Animals, Birds.. Common Waste water, Natural Water, Soil, Vegetation. General Characteristics: Gram-ve Bacilli, Facultative Anaerobes, Oxidase-negative.. Part Intestinal Normal Flora.. Humans, Animals, Birds.. Common Waste water, Natural Water, Soil, Vegetation. Opportunistic Pathogens/Obligate Pathogens.. Enterotoxins, Endotoxins, Capsules, Flagella, Pili Opportunistic Pathogens/Obligate Pathogens.. Enterotoxins, Endotoxins, Capsules, Flagella, Pili Coliform Group: Coliform Group: 1. Escherichia coli: Urinary Tract Infect (40-70%)..Single Organism, Septicemia, Neonatal Meningitis, Wounds. 1. Escherichia coli: Urinary Tract Infect (40-70%)..Single Organism, Septicemia, Neonatal Meningitis, Wounds. Diarrheagenic E coli strains: Diarrheagenic E coli strains: - Enteropathogenic:Infants.. mild-chronic diarrhea, Enterotoxigenic.. Heat-Labile/Stable Enterotoxin, Watery diarrhea.. More Children than Adults.. Travelers diarrhea..Contamination Water/Vegetables / Fresh food - Enteropathogenic:Infants.. mild-chronic diarrhea, Enterotoxigenic.. Heat-Labile/Stable Enterotoxin, Watery diarrhea.. More Children than Adults.. Travelers diarrhea..Contamination Water/Vegetables / Fresh food

3. Coli-form group-2 Coli-form group-2 dairy products..Mostly Self-limited.. No need for Antibiotics treatment. dairy products..Mostly Self-limited.. No need for Antibiotics treatment. - Enterohaemorrhagic.. Common in intestinal Cattels, verotoxins.. Contamination Ground meat/Hamburger,Dairy products..Bloody diarrhea.. Haemolytic-ureamic syndrome, pertonitis, Kidney failure..Outbreaks of infections. E. coli is used as indicator for detection of water & Food fecal contamination. E. coli is used as indicator for detection of water & Food fecal contamination. 2. Klebsiella-Enterobacter –Serratia species: UTI, Septicemia, Wounds.. Rare Meningitis.. Common Hospitalized patients. K. pneumoniae.. Large polysaccharide.. capsule.. Nosocomial Pneumonia. K. pneumoniae.. Large polysaccharide.. capsule.. Nosocomial Pneumonia.

4. E. coli Culture – Red color on MaConkey agar indicates Lactose-positive & Gram-stain

5. E.coli-Flagella-Fimbriae-Pili Klebsiella pneumonia-Capsule E.coli-Flagella-Fimbriae-Pili Klebsiella pneumonia-Capsule

6. Coliform group-3 E.coli, Klebsiella-Enterobacter –Serratia spp.. Lactose+ve, urease-ve & oxidase-negative.. E.coli, Klebsiella-Enterobacter –Serratia spp.. Lactose+ve, urease-ve & oxidase-negative.. Klebsilla spp. often encapsulated.. Non-motile Klebsilla spp. often encapsulated.. Non-motile 3. Proteus-Providencia-Morganella species: Lactose-ve & urease positive.. cause UTI, Septicemia, Wounds.. Commonly in Hospitalized patients. 3. Proteus-Providencia-Morganella species: Lactose-ve & urease positive.. cause UTI, Septicemia, Wounds.. Commonly in Hospitalized patients. Lab Diagnosis: All Enteric bacteria grow on MacCokeny-, Blood-, CLED-agar. Full identification done using Biochemical Tests.. Antibiotic Susceptibility must be done. Lab Diagnosis: All Enteric bacteria grow on MacCokeny-, Blood-, CLED-agar. Full identification done using Biochemical Tests.. Antibiotic Susceptibility must be done.

7. 4. Pseudomonas group Gram-ve bacilli, Oxidase-positive, Single polar flagellum,Fimbriae, obligate aerobe, widely distributed in human intestine, animal, plants, environment & water. Survive in disinfection solutions.. 70% Alcohol..contaminate Hospital sinks & equipments. Gram-ve bacilli, Oxidase-positive, Single polar flagellum,Fimbriae, obligate aerobe, widely distributed in human intestine, animal, plants, environment & water. Survive in disinfection solutions.. 70% Alcohol..contaminate Hospital sinks & equipments. P. aeruginosa: Most common causes of human & animal infections.. Produce several hemolytic- protolytic enzymes, toxins, fluorescent pigments- pyocyanin / Burn-Blue Green Pus.. can overcome host defenses.. Wounds,, External Otitis Media, Septicemia, Pneumonia, UTI, Nosocomial Infection, Mutlidrug Resistance.. Intrinsic-R to many antibiotics..Common Nosocomial/ opportunistic Pathogen. P. aeruginosa: Most common causes of human & animal infections.. Produce several hemolytic- protolytic enzymes, toxins, fluorescent pigments- pyocyanin / Burn-Blue Green Pus.. can overcome host defenses.. Wounds,, External Otitis Media, Septicemia, Pneumonia, UTI, Nosocomial Infection, Mutlidrug Resistance.. Intrinsic-R to many antibiotics..Common Nosocomial/ opportunistic Pathogen.

8. 5-Salmonella group Gram-ve bacilli.. Lactose-ve, urease-ve, Motile, Facultative Anaerobes.. Endotoxin/LPS, Cytotoxin.. common in Nature.. Humans, most domestic & wild Animals, Birds, Reptiles..Develop of specific antibodies during invasive infection against their O/H- Antigens.. Gram-ve bacilli.. Lactose-ve, urease-ve, Motile, Facultative Anaerobes.. Endotoxin/LPS, Cytotoxin.. common in Nature.. Humans, most domestic & wild Animals, Birds, Reptiles..Develop of specific antibodies during invasive infection against their O/H- Antigens.. Salmonellosis: Salmonellosis: 1-Gastroenteritis/ Food-poisoning Salmonella: S. enterica/ enteritidis.. Numerous Serotypes.. Common Farm Chickens, Pets.. Contamination Chicken Meat- Eggs, Water.. Fecal-Oral Infection.. Incub. 8-24 h.. Mild-Severe Diarrhea, Vomiting, Fever.. Mostly Self- Limited in Adults. More severe infection in children.. Septicemia-Meningitis in Immuno-compromised Pat. 1-Gastroenteritis/ Food-poisoning Salmonella: S. enterica/ enteritidis.. Numerous Serotypes.. Common Farm Chickens, Pets.. Contamination Chicken Meat- Eggs, Water.. Fecal-Oral Infection.. Incub. 8-24 h.. Mild-Severe Diarrhea, Vomiting, Fever.. Mostly Self- Limited in Adults. More severe infection in children.. Septicemia-Meningitis in Immuno-compromised Pat.

9. V. cholerae – Salmonella/ Flagella

10. Hekton – Enteric agar for Isolation of Salmonella (E.coli-Salmonella growth)

11. Typhoidal Salmonella 2- Typhoidal Salmonella: Human Enteric Fever.. Salmonella enterica /subtype Typhi & Paratyhi A, B, C., Fecal-Oral route, Fecal water contamination or drinks/ Fresh Food.. Intestine..Blood, Meningis,Urinary tract.. Incubation Period 1-3 Weeks, high Fever up to 42, Diarrhea, constipation, Septicemia, Meningitis, Hepatospenomegaly, Intestinal Perforation.. Healthy Carriers.. Mostly females in Gallbladder.. Less Intestine.. Repeat chronic infection.. Stool Excretion..single cases and community water outbreaks. Lab Diagnosis: Culture Feces, blood, Urine, CSF, Selective Media.. Serological Widel Test for detection of specific antibodies against O & H antigens ( Titer > 160 ).. Antibiotic, Human vaccine available. Lab Diagnosis: Culture Feces, blood, Urine, CSF, Selective Media.. Serological Widel Test for detection of specific antibodies against O & H antigens ( Titer > 160 ).. Antibiotic, Human vaccine available.

12. 6-Shigella group Shigella species.. Gram-ve bacilli, cause Only human disease.. Endo/Enterotoxins.. Susceptible to Dryness, Acid, Low-High Tempt. Fecal-Oral infection.. Water, fresh Vegetations, Common serotypes, S. Sonnei, Sh.boydii Sh. flexneri Purulent-Bloody- Diarrhea..Fever abdominal pain..Recovery 2-4 days with treatment.. No chronic healthy Carriers. Shigella species.. Gram-ve bacilli, cause Only human disease.. Endo/Enterotoxins.. Susceptible to Dryness, Acid, Low-High Tempt. Fecal-Oral infection.. Water, fresh Vegetations, Common serotypes, S. Sonnei, Sh.boydii Sh. flexneri Purulent-Bloody- Diarrhea..Fever abdominal pain..Recovery 2-4 days with treatment.. No chronic healthy Carriers. S.dysenteriae.. Enterotoxin (Neurocytotoxin), Severe Necrosis, high Fever, Severe Purulent-Bloody-Diarrhea S.dysenteriae.. Enterotoxin (Neurocytotoxin), Severe Necrosis, high Fever, Severe Purulent-Bloody-Diarrhea & Abdominal Cramps, CNS affection.. Rare Septicemia. & Abdominal Cramps, CNS affection.. Rare Septicemia. Lab Diagnosis: Feces Culture.. S-S Agar, Hecton – Enteric Agar.. Recommended Antibiotic Treatment, Control Sanitation & hygiene.. water, fresh Food. Lab Diagnosis: Feces Culture.. S-S Agar, Hecton – Enteric Agar.. Recommended Antibiotic Treatment, Control Sanitation & hygiene.. water, fresh Food.

13. 7-Vibrio cholerae Gram-ve Vibrios.. Oxidase-positive & Motile, Aerobic Alkaline Medium (pH >8-9)..Killed in low acidity.. Survive in saline water for long time.. Endemic In India/Bangladish.. Highly infectious.. Epidemic Human Outbreaks.. Water, Fresh Green leaves & Food Gram-ve Vibrios.. Oxidase-positive & Motile, Aerobic Alkaline Medium (pH >8-9)..Killed in low acidity.. Survive in saline water for long time.. Endemic In India/Bangladish.. Highly infectious.. Epidemic Human Outbreaks.. Water, Fresh Green leaves & Food V. cholera-01: Type V. cholera El-Tor.. Only Human.. Fecal-Oral Infection, multiply small intestine..release Cholera-toxin.. Heat-labile enterotoxin, Incub. 8-48 h.. Severe Watery Diarrhea, Dehydration, Shock.. Death. Within 24 hrs..No invasive infection. V. cholera-01: Type V. cholera El-Tor.. Only Human.. Fecal-Oral Infection, multiply small intestine..release Cholera-toxin.. Heat-labile enterotoxin, Incub. 8-48 h.. Severe Watery Diarrhea, Dehydration, Shock.. Death. Within 24 hrs..No invasive infection. Lab Diagnosis: Feces Culture.. Selective TCBS agar. Lab Diagnosis: Feces Culture.. Selective TCBS agar. Treatment: Replacement Fluids & Electrolytes.. Antibiotic.. Public Heath Measurements.. Human Vaccine recommended for Refuges & Army. Treatment: Replacement Fluids & Electrolytes.. Antibiotic.. Public Heath Measurements.. Human Vaccine recommended for Refuges & Army.

14. Cholera Cholera

15. TCBS agar for isolation of V.cholerae/ Salmonella – Shigella agar (Lactose-negative)

16. 8-Brucella species 8-Brucella species Brucellosis/Malta Fever.. Gram-ve coccobacilli..Non- motile, Intracellular, Endotoxins.. Primarily a Pathogens of Animals (Zoonosis), Localized Infection in reproductive Organs.. Sepsis, Abortions. Brucellosis/Malta Fever.. Gram-ve coccobacilli..Non- motile, Intracellular, Endotoxins.. Primarily a Pathogens of Animals (Zoonosis), Localized Infection in reproductive Organs.. Sepsis, Abortions. Br. abortus (Cattel), Br. melitensis (Goats/Sheep). Br. abortus (Cattel), Br. melitensis (Goats/Sheep). Human Brucellosis/Malt Fever : Mostly Br. melitensis.. Rare Other species in Jordan. Human Brucellosis/Malt Fever : Mostly Br. melitensis.. Rare Other species in Jordan. Transmitted to Humans.. Unpasteurized Milk/Milk Products.. Cheese, Direct Animal Contact.. Few Cells Enter Through GI, Skin Abrasions, Eye, Inhalation/Droplets.. Intracellular..Lymphatic System.. Septicemia, Meningitis, Chronic disease Transmitted to Humans.. Unpasteurized Milk/Milk Products.. Cheese, Direct Animal Contact.. Few Cells Enter Through GI, Skin Abrasions, Eye, Inhalation/Droplets.. Intracellular..Lymphatic System.. Septicemia, Meningitis, Chronic disease

17. Brucella-2 Clinical Features: Incub. 1-6 Weeks.. Intermittent fever, headaches, fatigue, joint and bone pain, GI Symptoms, Sweats, Back Pains, Acute- Subacute- Chronic Infections. Clinical Features: Incub. 1-6 Weeks.. Intermittent fever, headaches, fatigue, joint and bone pain, GI Symptoms, Sweats, Back Pains, Acute- Subacute- Chronic Infections. Common Complications: Arthritis, Meningitis-CNS, Osteomylitis, Localized Lesions in any body part. Common Complications: Arthritis, Meningitis-CNS, Osteomylitis, Localized Lesions in any body part. Lab Diagnosis: Culture Blood, CSF, Bone marrow (Chronic Infection).. Brucella agglutination Test.. Specific Antibodies Lab Diagnosis: Culture Blood, CSF, Bone marrow (Chronic Infection).. Brucella agglutination Test.. Specific Antibodies Treatment: 6-8 Weeks with Antimicrobial drugs Treatment: 6-8 Weeks with Antimicrobial drugs Prevention: Control Brucella in Animals by slaughtering infected animals.. Animal Vaccination, Pasteurization Milk/ Milk Products Prevention: Control Brucella in Animals by slaughtering infected animals.. Animal Vaccination, Pasteurization Milk/ Milk Products

18. 9-Campylobacter Species 9-Campylobacter Species Campylobacter jejuni, is Gram-negative slender, curved, motile by one/ two polar Flagellium, Spiral form, Grow Microaerophilic at 37-42..Normal Intestines flora all Birds, Animal..dogs, cats.. contaminated often Chicken Meat, Milk, food, water. Campylobacter jejuni, is Gram-negative slender, curved, motile by one/ two polar Flagellium, Spiral form, Grow Microaerophilic at 37-42..Normal Intestines flora all Birds, Animal..dogs, cats.. contaminated often Chicken Meat, Milk, food, water. It is primarily an animal pathogen causing abortion and enteritis in sheep and cattle. It is primarily an animal pathogen causing abortion and enteritis in sheep and cattle. Common cause of food-poisoning, important enteric pathogen since 1976.. In Western Countries. Common cause of food-poisoning, important enteric pathogen since 1976.. In Western Countries. C. jejuni.. Incubation 2-5 days..release Cytotoxins.. Intestinal inflammation..causes mild-moderate bloody- water diarrhea, Children.., Other symptoms often present are fever, abdominal pain, nausea, headache and muscle pain..Rare Sepsis & complication Arthritis, C. jejuni.. Incubation 2-5 days..release Cytotoxins.. Intestinal inflammation..causes mild-moderate bloody- water diarrhea, Children.., Other symptoms often present are fever, abdominal pain, nausea, headache and muscle pain..Rare Sepsis & complication Arthritis, Diagnosis: Stool culture.. Selective culture Media Diagnosis: Stool culture.. Selective culture Media

19. Cambylobacter Cell morphology Cambylobacter Cell morphology

20. 10-Helicobacter Species 10-Helicobacter Species Helicobacter pylori is a spiral shaped bacterium..One polar flagella.. Colonize only mucus lining cover mucosa of Gastric Antrim.. and duodenum.. Produce extensive Urease..Split urea to Ammonia..release Cytotoxin.. Mild-sever ulceration Helicobacter pylori is a spiral shaped bacterium..One polar flagella.. Colonize only mucus lining cover mucosa of Gastric Antrim.. and duodenum.. Produce extensive Urease..Split urea to Ammonia..release Cytotoxin.. Mild-sever ulceration The stomach is protected from its own gastric juice by a thick layer of mucus that covers the stomach lining. The stomach is protected from its own gastric juice by a thick layer of mucus that covers the stomach lining. Helicobacter colonize and infect only humans worldwide, where up to 10% of children & 80% of adults can have evidence of an H. pylori infection - usually without having any clinical signs or symptoms. Helicobacter colonize and infect only humans worldwide, where up to 10% of children & 80% of adults can have evidence of an H. pylori infection - usually without having any clinical signs or symptoms.

22. Helicobacter

23. Helicobacter Species-2 Helicobacter Species-2 Common symptoms: gastritis or peptic ulcer /Stomach.. duodenal ulcers..burning, Abdomen Pain, Nausea, Vomiting. Common symptoms: gastritis or peptic ulcer /Stomach.. duodenal ulcers..burning, Abdomen Pain, Nausea, Vomiting. Persistence of ulcers.. Development of Stomach Cancer and Lymphoma..1-3% Persistence of ulcers.. Development of Stomach Cancer and Lymphoma..1-3% H. pylori can be successfully eradicated using a combination of certain antibiotics and medicines that suppress stomach acid production. Common Re- occurrence of infection & disease H. pylori can be successfully eradicated using a combination of certain antibiotics and medicines that suppress stomach acid production. Common Re- occurrence of infection & disease Diagnosis: Urea Breath Test, Culture Stomach Biopsy.. Culture on Selective Medium.. 42C.. Diagnosis: Urea Breath Test, Culture Stomach Biopsy.. Culture on Selective Medium.. 42C.. Serological test for specific antibodies is not significant Serological test for specific antibodies is not significant