• Most common source: Poultry (Chicken)
• Non-Sacrylitic
• Gram - Bacilli (Gull-winged)
• Medium: CAMPe Blood Agar
• 42°C, 5% O₂, 10% CO₂, 85% N
• Hippurate +
• Oxidase +
• Catalase +
• Spread by Direct contact, exposure to animals, contaminated water, dairy products, improperly cooked poultry, & sexual transmission
• Self-Limiting in MOST people
• Can cause septic arthritis, meningitis, & pre-disposes people to Guilliane-Barre Syndrome (paralysis)

• Formally Campylobacter
• microaerophilic
• capnophilic
• motile
• strongly urease +
• produces endotoxin, but less toxic than endotoxins from other Gm -'s
• Medium: CAMPe blood plate
• Beta-hemolytic
• incubation = 3-5 days
• resistant to quinnalones, macrolides
• penicillins do NOT work well in stomach B/C of acidity in stomach

H = Haemophilus aprophilus

A = Actinobacillus actinomyecetemcomitans

C = Cardiobacterium hominis

E = Eikenella corrodens

K = Kingella

• Gm - Fastidious Bacilli
• Needs CO₂ atmosphere OR special nutritional requirements
• Grows SLOWLY
• Can enhance growth by putting into candle jar

• Haemophilus = Blood Loving
• X-factor = Hemin (Blood)
• V-factor = NAD (Staph/Neisseria)
• Problem: dies Rapidly!!
• Most will NOT grow on plain Blood Agar - need Choc. Agar
• Temps: 27-37°C
• Mousy, bleach-like odor
• pleomorphic
• H. aprophilus - X & V Independent!
  • Catalase -
  • Oxidase -
  • grows on blood, but better on choc. -- NO growth on MacConkey
  • Illnesses:
    • Sinusitis
    • Ear infections
    • Endocarditis (if gets into blood)
• H. aegyptus - X & V Dependent!
  • Causes Pink Eye & Brazilian purpuric fever
• H. ducreyi - X Dependent!
  • STD (Chanchroid)
• H. influenza - X & V Dependent!
  • Causes meningitis mainly in kids <2 B/C have NOT been vaccinated yet
  • VF's:
    • capsule
    • endotoxin
    • adherence w/ fimbriae
    • produces protease
  • does NOT cause influenza!!!

• animal pathogen
• non-motile
• usually assoc. w/ mouth flora
• in humans, caused:
  • meningitis
  • UTI
  • endocarditis
  • dental infections
• like CO₂.....candle jar
• fermentative
• looks like star on media
• occasionally shows in throat cultures
• inubation temp = 24+ hrs
• catalase +
• oxidase -
• do NOT grow on enteric media, rather grows nicely on choc. agar
• usually NEVER isolated by itself
• causes Wompey Jaw (in cows)

• non-motile
• alpha-hemolytic
• catalase -
• oxidase +
• causes pitting in media
• normal flora in nose, mouth, throat & GI tract

• yellow pigment
• ~50% of strains corrode agar in for of pitting
• Aroma: bleach
• non-motile
• catalase -
• oxidase +
• non-sacrylitic
• indole -
• causes:
  • periodontal infections
  • clenched fist syndrome
  • skin popping syndrome
    • caused by licking needles before drug use
    • lesions around injection site ocurrs

• part of Neisseria group
• coccobacillus
• grows better at 42C
• glucose fermenter
• nitrate +
• oxidase +
• catalase -
• "twitching" motility

• usually causes wound infections assoc. w/ animal bites
  • osteomilitis (bone infection) & resp. tract infections can develop
• does NOT grow on MacConkey --> but on Blood or Choc. Agar
• Oxidase test = VERY weak/delayed!!
• Catalase +
• Indole +
• Gram Stain = Bipolar stain (safety pin)

• Tularemia - Rabbit Fever
  • Reservoir = Rabbits
  • Highly Infectious Disease
• grows poorly on MacConkey
• Oxidase -
• Biochemically INERT
• growth enhanced w/ sulfur-containing amino acids (i.e. Cystine)
• can be transferred mother to baby rabbits via oavries
• people who hunt rabbits more prone to disease
  • usually from break in skin while skinning & cleaning
• most common clinical symptom: small sores that appear where bacteria enters body
• bacteria engulfed by WBC's, but NOT destroyed....enter bloodstream causing:
  • high fever
  • chills
  • shaking episodes
  • debilitating headaches
• diagnosing = HARD!
  • common to other diseases
  • good to know history of pt
• culturing = HARD!
  • usually done serologically
• responds to antibiotics, esp. tetracyclins!

• Whooping Cough
• Reservoir = Humans
• VERY CONTAGIOUS!!
• can be life threatening in infants ot pt's w/ cardiac or pulmonary conditions
• aerobic
• slow growing (2-3 days)
• needs complex media containing blood & potatoes
  • Bordet-Gengou Agar (Cough Plate)
  • colonies look silvery, metallic
• vaccine: DPT (to prevent) BUT complications occur - cause:
  • fever
  • convulsions
  • CNS problems
• ID:
  • fluorescent antibody test
  • Biochem Tests = INERT
  • DIFFICULT!!!!

• Brucellosis
• Undulant fever, Malta Fever
• Zoonotic
• does NOT grow on enteric media, instead on Bloog & Choc. Agar
• ~5-7 days to grow
• H₂S +, BUT use lead strips which are put into culture - will not do this for TSI or SIM
• B. abortus
  • cattle
  • causes spontaneous abortion in cows
• B. suis = pigs
• B. melitensis = goats/sheeps
• seen mainly in people who have gone abroad B/C many countries do NOT pasteurize their dairy products
  • U.S. pasteurizes ALL dairy product

• Legionnaire disease
• microbe likes moist areas (pipes, showers, misters in supermarket, etc.)
• causes resp., pulmonary infection
• treated w/ antibiotics
• only grows on media w/ iron, decreased amount of sodium, & amino acid L-cysteine
  • Buffered-Charcoal
    • contains yeast extract
    • microbe tiny & glistens
    • does NOT grow on blood or choc.
• Hippurate +
• most biochem tests = INERT
• survives temps up to 60°C
• can adhere to rubber, piping, plastics - able to stay in water systems, even if systems flushed out!
• resistant to chlorine!! (Bleach NOT work)
• rapidly ID'd by ELISA test
• symptoms:
  • flu-like or pneumonia
  • nausea
  • diarrhea in ~50% cases
  • decrease in blood O₂ level
    • problem: most elderly misdiagnosed as having dementia

• Gm - diplococci
• capnophiles
• oxidase +
• MOST catalase +, EXCEPT N. elongate
• inhabit mucus membrane in resp. & urogenital tract
• primary human pathogens:
  • N. meningitidis
  • N. gonorrhea
• VF's:
  • capsule
  • pili
  • LPS (endotoxin)
  • IgA proteases
• specimen collection:
  • vaginal smears/swabs
    • NO COTTON SWABS B/C inhibitory!
  • penal discharge
  • blood
  • joint fluid
  • throat swabs
  • special transport media
  • susceptible to cold temps
• Lab ID:
  • smear - look for diplococci
  • use choc. & NYC agar
  • samples streaked in Z-formation
  • incubate @ 35-37°C in CO₂ (candle jar)
  • sugar fermentation:
    • CTA Agar
      • N. gonorrhea - CTA w/ GLU
      • N. meningitidis - CTA w/ GLU & MAL
      • N. catarrhalis - Asacrylitic
    • look for growth patterns
    • RED --> YELLOW = +
• Immunological tests:
  • fluorescent antibodies
  • quellung - capsule swelling
  • some strains:
    • penicillinase +
    • beta-lactamase +
  • catalase test
    • use 30% instead of 3% H₂O₂
      • Neisseria bubbles, but is WEAK!

• epidemic spinal meningitis
• humans ONLY host
• 3-30% pop. asymptomatic
• ~14% cases FATAL
• if recover, many have:
  • permanent hearing loss
  • mental retardation
  • loss of limbs (B/C of DIC)
• NOT resistant!
  • penicillins, antibiotics, sulfur drugs WORK
• specimen collection:
  • CSF
  • blood
  • nasal pharyngeal swabs
• once collected:
  • gm stain - CSF centrifuged 1st to increase 100 fold of finding microbe
  • grown in candle jar
  • grows on blood, but Choc. is better
    • look small & gray and kind of muccoid

• Pili - Virulent - T1 & T2
• NO Pili - Avirulent - T3 - T5
• transmitted sexually
• primary reservoir = asymptomatic carrier
• incubation period = 2 days - 1 wk
• Males:
  • acute urethritis resulting in white/yellow discharge
  • burn upon urination
  • painful/swollen testicles w/ 3-5% being asymptomatic
• Females:
  • ~50% asymptomatic
  • vaginal bleeding
  • lower abdominal pain
  • can lead to PID (pelvic inflammatory disease)
    • internal absesses
    • long-lasting
    • damage to fallopian tubes
      • can lead to infertility
    • ectopic pregnancies
      • when egg grows outside of uterus
      • can be life threatening
    • can cause infections in rectal area (bloody stools), pharyngitis, blindness, etc.

• M. catarrhalis (formally Branhamella)
  • ONLY isolated in humans
  • Normal flora in resp. tract
• opportunistic
• causes:
  • pneumonia
  • sinusitis
  • ear infections
• contains beta-lactamase
  • resistant to penicillin-derivatives
• oxidase +
• catalase +
• grow on sheep blood choc. agar
• sugar tests -
• DNAse + (turns plate red)

• Most oxidase +
• Most non-reactive on TSI
• Most resistant to antibiotics
  • prob. B/C tend to be nosocomial
• organized into smaller grps based on:
  • growth on MacConkey
  • Oxidase +/-
  • whether microbe can use glucose oxidatively?
• most commonly isolated:
  • pseudomonas aeruginosa
  • xanthomonas maltophila
  • Acinetobacter sp.
• Biochem tests:
  • TSI - non-reactive, stays red
  • OF Medium - Weak/Strong +
    • ferments glucose EXCEPT pseudomonas in closed tube w/o oil

• aerobic
• oxidase +
• motile
• grows on MacConkey
• oxidizes carbohydrates
• produces blue/green pigment - pyocyanin
• grape, fruity odor
• diseases:
  • primarily wound infections
  • pulmonary infections
  • burn infections
  • Jacuzzi/Hot Tub Syndrome
    • necrotizing skin rash
• VF's:
  • LPS (endo- & exotoxin)
  • homolysin
  • anti-phagocytic slime layers
  • elastase (breaks down collagen)
  • coagulase +
  • DNAse +
  • Lipase +
• grows at 42°C
  • can tolerte HIGH temps
• Citrate +
• blue/green sheen on media
• Treatment = HARD! B/C resistant to many antibiotics
  • double drug therapy used

• oxidative
• plant pathogen
• used to be considered low-grade
• assoc. w/ pneumonia in pt's w/ cystic fibrosis
• causes pneumonia & dermatitis
• isolated from contaminated water, anesthestics, nebulizers, disinfectants, detergents
• tends to grow better @30°C

• oxidative
• 3rd most common Gm - nonfermenter isolated
• WAS considered plant pathogen, BUT also assoc. w/ water, sewage
  • NOW, human pathogen
• isolated in hospital as well
• VERY resistant to antibiotics
  • treatment = HARD!
  • quinnalones used

• motile
• primary intestinal pathogen
• inhabits GI tract of animals
• H₂S +
• urease -
• non-lactose fermenter
• VF's:
  • LPS
  • w/ fimbriae = more virulent B/C can adhere to intestinal mucosa
  • enterotoxin (like shigella - Shiga toxin)
    • cause GI problems
• to isolate - enrichment media used
• VERY susceptible to chem. agents (disinfectants)
• diseases:
  • Salmonellosis
    • GI problem
    • vomiting/diarrhea
    • fecal-oral route from person to person
    • NO animal reservoir
    • symptoms:
      • high fever
      • pain from ulcerations in intestinal tract
      • mucus, blood, pus in stool
    • pt gets better within a few days
  • Typhoid fever
    • MOST severe of enteric fevers
    • prolonged fever
    • microbe moves to multiple organs in body
    • spread person to person
    • NO animal reservoir
    • can be transmitted thru fomites
    • Symptoms start 9-14 days after contact w/ Salmonella typhi:
      • fever
      • muscle pains
      • malaise
      • frontal headache
      • microbe invades gall bladder & intestines - remains viable
      • can terminate by antibiotics OR surgically removing gall bladder
  • Food poisoning = common
    • 8-36 hrs after ingestion
    • nausea, vomiting, diarrhea
    • worst in young kids/elderly

• motile
• primary intestinal pathogen
• pneumonic/bubonic plague
• Gm - bacilli
• grow @ 37°C, but prefer 25-30°C
• stain bipolar (safety pin)
• humans can pick up from pets (cats, dogs, pigs)
• appears as Appendicitis
• can produce arthritis & itchy, red nodules & burn - more prevalent in females
• Y. enterocolitica
  • mimics GI problems
  • most commonly from contaminated water
• Y. pestis
  • buboes/lesions along lymphatic system
  • can become resp. (pneumonic)
• Y. pseudotuburculosis
  • primarily attacks rodents
  • extremely rare as human infection

• 4 different species:
  • S. sonnei
  • S. flexneri
  • S. boydii
  • S. dysenteriae
• cause basillary dysentry
  • produce mucus/blood/pus in stolld B/C of ulceration of colon
• Non-Motile
• primary intestinal pathogen
• NO animal reservoir
• S. sonnei = most common in U.S.
  • Grp D
  • H2S -
  • NO gas production from glucose fermentation
  • non-lactose fermenter
  • colonies very fragile in terms of environmental changes

• Non-motile
• Klebsiella pneumoniae - possesses polysaccharide capsule to prevent phagocytosis
• assoc. w/ resp. tract infections of hospitalized pts
• causes lower resp. tract infections

• motile
• isolated from wounds, urine, blood, CSF

• motile
• opportunistic
• SLOW lactose fermenter
• Resistant to many antimicrobials
• Serratia marcescens
  • pink/red color
  • found in nosocomial infections of urinary/resp. tract & in bacteremic outbreaks in nurseries, cardiac surgeries, & burn units

• motile
• delayed + citrate rxn
• causes gastroenteritis
• occassionally isolated from stools

• motile
• opportunistic
• normal intestinal flora
• deaminates PHE
• lactose -
• urease +
• H₂S +
• Odor - burned choc./choc. cake
• isolated from wounds, urine, ears, & bacteremic infections

• motile
• causes UTI & diarrheal illness

• motile
• causes UTI
• occasional nosocomial outbreak in burn units
• found in feces of children w/ diarrhea
• isolated from urine cultures of immunocompromised pts

• motile
• causes UTI, pneumonias, intra-abdominal absesses, endocarditis
• nosocomial infections
• isolated from diarrheal stools
• ~80% H₂S +
• mistaken for Salmonella

Enteropathogenic E. coli

(EPEC)

• infantile diarrhea
• symptoms:
  • low grade fever
  • malaise
  • vomiting
  • diarrhea
  • stool contains LOTS of mucus, NO blood

Enterotoxigenic E. coli

(ETEC)

• Traveler's diarrhea
• Symptoms:
  • nausea
  • abdominal cramps
  • low grade fever
• assoc. w/ contaminated food/water
• infective dose = HIGH (10⁶ - 10¹⁰ bacteria)
• stomach acidity - inhibits colonization & initiation of disease - Achlorhydria
• LT - heat labile toxin
• ST - heat stabile toxin
• Non-bloody, watery diarrhea
• lasts 1-5 days

Enteroinvasive E. coli

(EIEC)

• Dysentry
• penetrates, invades, & destroys intestinal mucosa
• via fecal-oral route
• symptoms:
  • fever
  • severe abdominal cramps
  • malaise
  • watery diarrhea
  • stool - pus/mucus/blood
• non-motile
• lactose -

Enterohemorrhagic E. coli

(EHEC)

• hemorrhagic diarrhea & colitis & hemolytic uremic syndrome (HUS)
• HUS:
  • low platelet count
  • hemolytic anemia
  • kidney failure
  • watery diarrhea --> bloody diarrhea
  • abdominal pain
  • low grade fever or NO fever
  • infection potentially fatal
• E. coli O157:H7
  • produces 2 cytotoxins:
    • Verotoxin I - phage encoded
      • identical to Shiga toxin
    • Verotoxin II

Enteroadherent E. coli

(EAEC)

• causes diarrhea
• adheres to mucosal surface of intestine
• symptoms:
  • watery diarrhea
  • vomiting
  • dehydration
  • abdominal pain

• urinary tract infections - UTI & kidney infections in humans
• Septicemia & meningitis
  • newborn acquires infection through birth canal

• plant cancer
• Crown Gall

LAB Diagnosis

of

Enterobacteriaceae

• Media:
  • non-selective - Blood/Choc.
  • Selective - MacConkey
  • Highly Selective - HE/XLD (for stools)
• lactose vs non-lactose fermentation**
  • MacConkey
    • lactose = pink/red
    • non-lactose = colorless
  • HE
    • lactose = salmon/orange
    • non-lactose = colorless
  • XLD
    • lactose = yellow
    • non-lactose = colorless
• Environmental Requirements:
  • 1-5°C for Serratia
  • 45-50°C for E. coli

ID

of

Emterobacteriaceae

• ALL oxidase -
• ALL ferment glucose
• ALL reduce nitrates --> nitrites

• referred to as enterics
• Gm - bacilli
• non-spore forming
• facultative anaerobes
• most present in intestinal tract of animals/humans as commensal flora
• live in soil, water, sewage
• plant pathogens
• opportunistic
• VF's:
  • ability to colonize, adhere, produce toxins & invade tissues
  • antigens:
    • O (somatic) - heat stabile; cell wall
    • H (flagellar) - heat labile; flagellum
    • K (capsular) - heat labile; in certain species
• Escherichia - E. coli
  • lactose fermenter
  • motile
  • contain pili & fimbriae
  • O, H, K antigen
  • Indole +
  • MR +
  • ferments glucose, trehalose, xylose
  • normal intestinal tract flora