Flashcards in Micro Enteric Bacteria 2 Deck (32)
-gram - rods
-seldom lactose fermenting
2. enteric fevers (typhoid)
4. risk of reactive arthritis (Reiter's syndrome)
-usually s. typhimurium, s enteritidis, s heidelberg
-bacteria invade gut wall (M cells) by fimbriae - immune containment
-MC in children and nursing homes in US
-high infectious dose
-cause inflammation and diarrhea, nausea, vomiting
salmonella enteric fever
high infectious dose, invasion of gut wall - specifically peyer's patches of distal ileum = transport in macrophages (trojan horse) to lymphatics and major organs and causes macrophage apoptosis, bacteremia, toxemia
-protected from humoral immunity by Vi capsul
virulence factors salmonella
1. ipf operon enhances adhesion to M cells in Peyer's patches
2. Type 3 secretion system injects M cell, enhances bacterial translocation
3. SipB injected by Spi1 type 3 system causes macrophage apoptosis
4. Vi antigen: s. typhi capsule for immune evasion
what is the difference between shigella and salmonella?
shigella lower infectious dose and risk of HUS
salmonella enteric and typhoid fevers symptoms
-onset: fever, malaise, diffuse abdominal pain, constipation
-3-4 week progression: dry cough, stupor, delirium, intestinal hemorrhage, bowel perforation, myocarditis, death
what causes hemorrhage/perforation in salmonella enteric/typhoid fevers
necrosis of the infected peyer patches
what pathogens use macrophage as trojan horse?
salmonella, TB, cryptococcus, histoplasma
penetration of gut by salmonella resisted by what?
CFTR cystic fibrosis allele (heterozygotes)
host risk factors for salmonella
corticosteroids, other immunosuppressants, malignancy, diabetes, HIV
-very rare in previously healthy adults
-underlying chronic disease like sickle cell predisposes
what are the most common sequelae to salmonella septicemia?
osteomyelitis, pneumonia, meningitis
1. enterocolitis: nonbloody diarrhea, fever, dehydration, culture from stool
2. typhoid: travel abroad, high fever, headache, tender abdomen, anorexia, sometimes rose spots (pink, blanchable, slightly raised), lethargy
3. septicemia: focal symptoms related to affected organ [bone (osteomyelitis), lung (pneumonia), meninges]
enteric fevers and septicemia: IV ceftriaxone or ciprofloxacin - drain focal abscesses
Yersinia enterocolitica and pseudotuberculosis bacteriology
-gram - oval rods
-lack yersinia pestis virulence factors (no plague)
-not lactose fermenting
-grows in cold
-motile at 25 C, non motile at 37
what does Yersinia enterocolitica and pseudotuberculosis cause?
Yersinia enterocolitica pathogenesis
high infectious dose
-penetration of mucosa occurs in ileum --> multiplication in Peyer patches (M cells) --> spread to local lymph nodes --> mesenteric lymphadenitis (false appendicitis)
Yersinia enterocolitica virulence factors
carried on chromosome and plasmid
1. pili and Inv adhesin enhance binding to M cells in Peyer's patches
2. CNF dermonecrotic toxin destroys tissue
3. Yop Type 3 secretion system injects proteins in macrophages (no phagocytosis = reduced inflammatory response)
what is there a risk for with Yersinia enterocolitica and pseudotuberculosis
similar to yersinia enterocolitica but rarer and seen with immunocompromised or liver disease
-may be associated with izumi fever in children (fever, rash, conjunctival injection, cervical lymphadenitis, inflammation of the lips and oral cavity, edema of hands and feet
Yersinia enterocolitica and pseudotuberculosis diagnosis
-exam: diarrhea, dehydration, false appendicitis
-lab: culture from stool or blood
grow well after cold-enrichment
how is pseudotuberculosis differentiated from enterocolitica?
pseudotuberculosis has fermentation of sorbitol and ornithine decarboxylase activity
listeria monocytogenes bacteriology
-small gram +
-blue-green sheen on non-blood agar
-forms Ls and Vs
-grows well in cold
-tumbling motility by termperature-sensitive flagella
what foods is listeria monocytogenes associated with?
unpasteurized dairy products, undercooked meat, raw veggies (cold food)
what does listeria cause?
gastroenteritis - usually in immunosuppressed and pregnant/fetus
what does listeria infection cause in pregnant women?
3rd trimester - escape GI and proliferate in the placenta
-causes preterm labor, abortion, stillbirth, intrauterine infection
what does listeria cause in the neonate?
-early onset sepsis and premature birth with abscesses and/or granulomas
-transmission from vagina during birth = late-onset meningitis with sepsis
listeria diagnosis on exam
previously healthy: watery diarrhea, fever, headache, cramps
pregnancy: fever, arthralgia, back pain, headache
immunocompromised: (think transplant!) CNS: mental status changes, seizures, cranial nerve deficits, strokelike hemiplegia, tremor, myoclonus, ataxia, brain abscess