g- negative aerobic bacilli: 1)facultative anaerobic fermenters. enterobacteriaceae - e.coli,...
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G- negative aerobic bacilli:
1) Facultative anaerobic fermenters . Enterobacteriaceae - E.coli, Salmonella, Schigella, Enterobacter, Citrobacter, Serratia, Klebsiella, Proteus, Morganella, Providencia,
Vibrionaceae: Vibrio, Aeromonas, Plesiomonas
Campylobacter, Helicobacter
2) Obligately aerobic nonfermenters: Pseudomonadaceae – Pseudomonas sp., Stenotrofomonas maltofilia, Acinetobacter
3) Haemophilus and related genera (Actinobacillus, Pasteurella)
4) Unusual bacilli (Bordetella, Franciscella, Brucella, Legionella, Afipia, Bartonella, Calymmatobacterium, Cardiobacterioum, Eikenella, Flavobacterium, Streptobacillus, Spirillum)
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Pseudomonas aeruginosa
Hospital enviromnemt – in food, cut flowers, toilets, mops, respiratory equipement, desinfectant solution
Persistent carriage less than 6% in healthy, 38% in hospitalised, 78% in immunocompromised
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Hospital - nosocomial infections• Hospital infection - infection, that arises in connection to hospitalisation or to
diagnostical, therapeutic or preventive processes. I does not necessary have to present during the hospitalisation and not every infection arising during hospitalisation is nosocomial
• Risk factors - age,accompanying diseases, surgical processes therapy - ATB, imunosupression, irradiation, not vital reservoire - indwelling catheters)
• Microbes
• Ways of transmission - in direct (inhalation, ingescion, inoculation) , direct (contact of infected skin or mucous membrane with healthy)
• Prevetion - organisation of health process, construction, food supply, health process technics, asepsis and antisepsis, nursery approches, isolation, monitoring, surveillance, role of microbiologickal laboratory)
• ATB therapy
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Role of microbes in hospital infections• Staphylococcus aureus - problems of per secundam healing wounds (70 ies). Virulence,
colonisation capacitiy, resistence - MRSA - methicilin resistent staphylococcus aureus (80 ies)
• G-rods (60% of HI) - urinary tract infections, respiratory infections, wound infection, GIT
• Opportunistic pathogens - Ps. aeruginosa (Hospital environmente – food, cut flowers, water, toels, mops, respiration devices, desinfection solutions. Persistent carriage in less than 6% helathy, 38% in hospitalised, 78% imunocompromised) and other non fermenting G- rods - Acinetobacter, Stenotrophomonas maltophilia, Burkholderia cepacia… - present in environmentí (Legionella pneumophila - climatisation)
• PK negative staphylococci - colonisation of plastic material of indwelling catheters
• Viruses - blood borne infection agenses HIV, VHB, VHC, CMV….
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ATB therapy in hospital infections• Overuse of ATBe - resistence and multiresistence (selection pressure of ATB
and transmission in hospital environment), toxic side effects, economic burden, deterioration of physiological microflora
• Racional indication - preventive in spread of HI
• Prophylaxis - oriented to anaerobe infectione - perioperative preparation for GIT and UGT surgery, in instrumental examination of patients with bacteriuria
• ATB surveys - monitoring of ATB susceptibility
• Restrictive policy - time restricted contraindication of some ATB
• Rotation of atb - periodical changes of used - decreasing of selection pressure
• Combination of atb - agains possible resistent mutnants, broader antimicrobial spectrum
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Primarily oportunistic
Structura factors and toxins – virulence factors
Nonfermentative – cytochromoxidase – dif.dg.
Capsule production
Diffusible pigments - pyocianin, pyorubin,
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VIRULENCE FACTORSPilli - adherence
Polysaccharide capsule – antifagocytic properties, anchor to bacteria
Endotoxin – LPS sepsis syndrome
Exotoxin A – most important, block eukaryotic cells proteosyntesis
Exoenzyme S – heat stability, inhibition of proteosynhesis
Elastane – destruction of elastase of blood vessels wall
Alkaline protease – tissu destruction
Phospholipase C – breaks down lipids and lecithin, tissue destruction,
Opportunistic, minimal nutritional requirements, temperature tolerant 4*- 42* C, resistant to ATB and disinfectants
Isolation without evidence of disease does not justify therapeutic intervention
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Clinical syndroms
Bacteraemia and endocarditis - originate in respiratory, UG tract or wound infections, i.v. drug abusers, tricuspidal valve, chronic course
Pulmonary infections . Colonisation – necrotising bronchopneumonia, cystic fibrosis infection, respiratory tract therapy equipement contamination, invasive bilateral bronchopneumonia with microabscess formation and tissue necrosis
Ear infections – external otits, swimmer´s ear – local infections invasive malignant external otitis – life threating, chronic otitis media
Burn wound infections – colonisation, vascular damage, tissue necrosis, bacteraemia. Moist surface of burns and neutropaenia
Urinary tract infection – indwelling catheters Oportunistic infections - moist reservoirs, circumvention, absence of host defenses – cutaneous trauma, elimination of normal flora by ATB, neutropenia Gastroenteritis, Eye infections, Musculosceletal infections
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Laboratory diagnosis
Cultivation – simple nutritional requirements, aerobic incubation, growth in broth air interface – presence of nitrate.
Identification – colonial morphology, rapid biochemical tests – COX, presence of pigment, characteristic odor
For epidemiological investigation – nucleic acid analysis, phagotypisation, pyocin typisation, serotyping
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Cultivation• Ps. aeruginosa on blood agar - mucous gray colonies with
methal lood and pigment and characteristic smell Production
of diffusibile pigment - pyocyanin and of capsule
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Biochemical properties of Ps.aeruginosa
• Minimal nutrition requirements, thermotolerant 4*- 42* C, rezistent to ATB and desinection Nonfermenting – cytochromoxidase – dif.dg. (COX test), Hajn tube medium - without change - red - detection of pigment and smell.On transparent media - green pigment
• Oportunistic: factors of virulence: Pilli - adherence Polysacharid capsule – antifagocytosis, attachment, Endotoxin – LPS sepsis Exotoxin A – most important, blocs proteosynthesis of eukaryotic cells Alkalic protease – destruction of tissu Phospholipase C – destruction of lipids and lecithin, destruction of tissue
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Other pseudomonas –
Ps. Pseudomallei – asymptomatic, melidiosis, - localised suppurative infection with lymphadenitis, fever, malaise, pulmonary disease (bronchitis – necrotising pneumonia) !!highly infectious in lab. processing
Ps. Cepacia – in immunocompromised respiratory and urinary tract infections, cystic fibrosis
Insignificant water born contaminant
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Treatment,
Frustrating – imunocompromised host defense typical ATB resistence induction of ATB inactivating enzymes transfer of plasmid mediated resistance
Aminoglycosides – ineffective in the site of infection (acidic encironment in abscess)
Combination of ATB – beta lactam+aminoglycosides, Sulfonamides,
Prevention,
Of contamination of sterile equipement and cross contamination of patients.
Broad spectrum ATB should be avoided – suppression of normal flora and overgrowth of resistant pseudomonas
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Stenotrophomonas maltophilia
- second most common isolated G-nonfermenter
- Opportunistic nosocomial pathogen
- Resistant to AMG and betalactams, IMI, fluoroquinolons (long term ATB therapy is predisposing to the infection with it)
- CMP,CEF,COT
Acinetobacter
-nosocomial respiratory infections
-moist environment (contamination of respiratory therapy equipment
-normal oropharyngeal flora
- AMG, IMI, AMI
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Bordetella pertussis – whooping cough, pertussis Boredetella parapertussis – parapertussis, like pertussis Bordetella bronchiseptica – respiratory in animals, occasionally in hum.
Franciscella tularensis – tularemia, zoonosis
Brucella melitensis – brucellosis, zoonosis Brucella abortus Brucella suis, Brucella canis - brucellosis
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BordetellaStrictly aerobic, 3 specimens – different growing characteristics and biochemical reactivities and antigenic properties - very similar Differing in expression of virulence factors:Bordetella pertussis – very fastidious, antigenic, virulent.Bordetella parapertusisBordetella bronchiseptica
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Bordetella pertussis – very fastidious, antigenic, virulent.
Pathogenesis – exposure to the bacteria and its attachment to the ciliated epithelial cells of bronchial tree, proliferation of bacteria, production of tissue damage, systemic toxicity
Pertussis toxin – 2 subunits A(active) multiple biological act., B(binding)
Filamentous hemaglutinin – attachement, hemaglutination -protective Ab
Adenylate cyclase toxin – interference with immune cells (inhibition)
Tracheal cytotoxin – ciliostasis,
Dermonecrotic toxin – vasoconstriction, tissue damage
LPS - endotoxin
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Epidemiology
Person to person
Immunised population – whole cell vaccine
Inadequately immunised children – risk
Clinical syndromes
Inhalation of infected droplets – catarrhal stage (1-2 weeks) – common cold sy – paroxysmal stage (2-4weeks) - extrusion of ciliated epithelial cells – whooping cought paroxysms – restricted airways by mucus – vomiting, lymphocytosis – convalescent stage – diminishing paroxysms - secondary complications.
Laboratory diagnosis – sensitive to drying, fatty acids in cotton are toxic, transport media or directly inoculated to Bordet Gengou plate Fluorescent microscopy, Humidified chamber - prolonged incubation – 7 days
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B.pertussis - sampling and cultivation• Sample from nasopharynx - on bound wire, humidity. Coughing plates - overgroth of
contaminating flora - (Blood agar + active charcoal +ATB, or Bordette Gengou) Bordetella pertussis – nutritionally very requiring, virulent. Pertussic toxin – 2 subunits: A (active) multiple biological effects, B(binding) Dermonecrotic toxin – vasoconstriction, tissue destructione Filamentous haemaglutinin – attachement, hemagglutination -protective Ab, Adenyl cyclase - toxin – interference with immunity cells (inhibition), Tracheal cytotoxin – cilliostasis, LPS - endotoxin Laboratory diagnosis Sensitiveto drying, fat acid in cotton of sampling devices are toxic, not living in common transport media, direct innoculation on Bordet Gengou plate. Humid chamber - prolonged incubation – 7 days Serology -Agglutination: patient serum + Ag B. pertussis - 2 samples in 14 days interval, 4 fold increase of titer, conversion from negat to pozit
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Treatment
-supportive, nursing supervision, ATB does not ameliorate the state – intoxication and destruction of epitelium
-ERY – eradication of bacteria, reduction of infectiosity
Prevention
whole cell vaccine ( combine with diphteria, tetanus and Hib or HB) associated complication
Acellular vaccine – imunogenicity ?
Serological diagnosis
Aglutination : patients serum + commercial Ag of B. pertussis
2 samples in 14 days interval, fourfold increace of titer.
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Legionella• 1976 – sever pneumonia of legionnaires – unknown G-
rod – faibly stainable ( impregnation with silver) , not growing on common media (nutrtiously very fastidious - requiring Fe salts and cystein)
• Everywhere present water saprofyt and human pathogen of respiratory system
• Several taxonomic groups 14 – medically important• Short coccobacilli, pleiomorfic, motile, catalase +, • Legionella pneumophila – most important
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Legionnaire´s disease• Inhalation of infektious aerosol,
i.c. parasit – able to grow and multiply in makrophages, inhibition of fusion of fagolysosomes proteolytical ensymes - fosfatase, lipase, nuclease. Cell imunity! ( immunocompromised - transplanted) or lung diseases (smokers)
• - climatisation devices, showerse – prolonged stay in closed contaminated humid environment – summer, autumn,
• Flu like disease Pontiac fever • sever pneumonia with multiorgan involvement Legionnaires
disease
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Legionnaire´s disease - diagnosis.
Fluorescence with labeled antibodies, Cultivation - cystein, Fe, pH 6,9, ATB against contaminating bacteria 35*C, 3-5 days, - identification based on the growth on special media Detection of antigen ( sputum or urine – present more than 1 year – sensitive, not specific
• Serological dg – detection of antibodies - titer above 256, longlasting persitence
• Therapy – not tested routinely, ERY, RiF, Fluorochinolon, not betalactmes
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Franciscella tularensis – tularemia,glandular fever, rabbit fever
Microbiology: Nonmotile, nonpilliated, lipid capsule, fastidious growth, prolonged cultivation (2-3 days) enriched media
Immunity:Intracellular parasite surviving in macrophages of RES antiphagocytic capsule in pathogenic strains endotoxin activities
Epidemiology: Worldwide distribution – wild annimals, domestic annimals, birds, fish, arthropods contaminated water. (rabbit, thicks)
Bite of infected arthropod (present in feces not saliva – prolonged feeding time) contact with infected annimals consumption of infected meat or water, inhalation of aerosol ( less than 10 organisms when bite, 50 organisms when inhaled and 106 when ingested)
Endemic – when the rabbit is so slow as to be shot or caught it is likely to be inficted.
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Clinical syndromes 3-5 days incubation, fever, chills, malaise, fatigues, clinical classification according to the site of infection, skin ulcers, lymfadenopathy: - ulcerogladular, glandular,typhoid, oculogladular, oropharyngeal, pneumonia
Laboratory diagnosis – extremely hasardous (can penetrate cross the skin and mucus)
Microscopy – from ulcers:small, stains faintly, fluorescein-labelled Ab Cultivation – chocolate lbood agar with cystein. Lab should be notified. Identification – aerobic, catalase positive, oxidase negative, agglutination Serology – 1 serotype only. Titer above 160 is suspected. (Cross reactivity with Brucella)
Treatement Prevention and control STM, GEN, attenuated and inactivated v.-ineffective TTC, CMP – relapses, avoid the reservoirs beta lactamase production
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Yersinia• 7 species - Y.pestis, Y. pseudotuberculosis, Y. enterocolitica, +
oportunistic Yersíniae• Y. pestis - plague - urban and forest type, not GIT disease. Adapted to
i.c. parasitismus, not surviving in nature. Virulence factors - i.c. surviving, , polysaccharide capsule, endotoxin, . Urban plague - circulating between rats, transmitted by insect to man during rodent bacteraemia. Replication in colon of insect and transmission to other rodent or man is on by chance. Forest pôague - Not controlled.
• 2 clinical formes - bubonic - 7 days after biting by insect - painful lymphadenopathy75% lethality - pneumonic - 2 days after inhalation - fever, pneumonia, inhalation spread by droptets, epidemia letality 90%
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flea
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Brucella• 6 species - 4 involved to human disease- brucelosis -
B. abortus, B. melitensis, B. suis, B. canis. • Brucellosis – many names acc. to the place of discovery or the person – Bangdisease nemoc,
Mediteranean fever Undulating fever.
Nonmotile nonencapsulated G- kokobacilli, slowly growing, very fastidious,
Intracelular pathogen, in RES cellMost virulent - B. mellitensis
World wide, annimal source
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• B. mellitnesis – goat, sheep - sever acute disease with complication , very common
• B. abortus - cattle – mild infection with pyogenic complications, not common
• B.suis - pig – pyogenic destructive chronic • B.canis - dog – mild pyogenic complication • Brucella – predilection place - tissue with
erythriol (in annimnals uterus, placenta, epididymis, mammalian gland) - sterility, abortus in annimals. Not in human
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Clinical sy, dg and therapy• Transmission from annimal (vet doctors) or food (not pasteurised
milk) or lab.infection ( direct contact or inhalation)
localised abscess - bacteremia – localised in RES (spleen, liver, bone marrow, lymfocytes, kidney) - granulomea
Subclinical subacute, chronic – general symptomes not specific . Undulant fever
Several sampling of material for serology or hemocultivationCultivation on enriched media, for 4 weeks
Th – TTC+ GEN, prolonged application of COT
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Brucelosis
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Other G- rods
• Eikenella
• Calmnobacterium
• .......
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Physiology and structure of Enterobacteriaceae
• G- rods, usually motile (flagella, not spore forming, facultative anaerobes, nutritionally not requiring, biochemical active catalase +, oxidase -, cytochromoxidase COX - = dif.dg.from Pseudomonadaceae
• Lactose fermentation + or -, rezistence to bile salts, capsule - dif.dg from other Enterobacteriaceae
• 3 types of antigens:
• - somatic O antigen - most important cell wall ag, heatstabile, LPS lipopoly saccharide consists of 3 parts - O polysaccharide, core polysaccharide and lipid A - with endotoxin activity
• - capsular K antige - heatlabile cross reacting with antibodies against other bacteria. In Salmonella typhi under name of Vi antigen
• - flagellar H antigen - heatlabile, antigen and phase variation
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• G- aerobe rods• 1) Facultatively anaerobic fermenters:
Enterobacteriaceae - E. coli, Salmonella, Schigella, Enterobacter, Citrobacter, Serratia, Klebsiella, Proteus, Morganella, Providencia Vibrionaceae - Vibrio, Aeromonas, Plesiomonas Campylobacter, Helicobacter
• Widest and most heterogenous group of medically important bacteria• 27 genus, 102 species (95% medically important ones belong to 25
species) - differentiation based on DNA homology, biochemical properties, antigen characteristics, ATB susceptibility
• Commonly present in nature (soil, water, plants), parts of physiological flora of colon.
• Obligatory pathogenic (Yersinia pestis), oprtunistic pathogens (Klebsiella, E. coli, Proteus)
• Transmission from annimals (Salmonella), from human carrier (S. typhi), endogenous infection (E.coli)
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Sites of infections
• CNS - E. coli
• URT infections - Klebsiella, Enterobacter, E. coli
• Septicaemia - E. coli, Klebsiella, Enterobacter
• GIT infections -Salmonella, Shigella, Yersinia, E.coli
• Urinary tract infections - E. coli, Proteus, Providencia, Klebsiella
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Factors of pathogenicity and virulence
• Endotoxin• Capsule• Antigenic variation• Production of exotoxin• Adhesins• i.c. surviving and multiplication• competition for growth factors• Resistence to bactericidsal activity of serum• resistence to ATB
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Biological effect of endotoxin• Part of G- bacteria cell wall - released after its destruction - by
ATB• Fever• leukopaenia followed by leukocytosis• activation of complement• Thrombocytopaenia• Disseminated intravascular coagulopathy DIC• decreased periferal circulation and perfussion of big organs• shock
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E. coli• Present in GIT• causes - endogennous infections after breaking of immune barieres from physiological flora ( z
focus in UGT or GIT, most important cause of G- sepses), Infection of urinary tract (most out patients infections - rises from GIT strains, specific serotypes binding with specific adhesis to epitel receptors), - gastroenteritis - neonatal meningitis
• enterotoxigen ETEC - production of heatstabile and heat labile toxin, mild water diarhoea, travellers diarhoea,
• enteroinvsive EIEC - spread to epithelial cell of the colon, destruction of epithel, fever, blood and leu in stool, Confirmation of invasivness - Sereny´s test - innoculation of strain do conjunctiva of annimal- results in inflamation enteropathogenic EPEC - serious child diarhoea , shiga-like toxin, able to adhere to erytrocytes
• enterohemorhagi EHEC - production of verotoxin. From non complicated diarhoea to
hemorhagic colitis and . Hemolytic-uremic sy - type 0157:H7, - acute kidney insufficiency, trombocytopaenia, in children under do 5 r.
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Salmonella• 1500 serotypes, different names according to place of identification• DNA analysis = 1 species (S. enterica) and its 7 subgroupes• Present in annimals, spread by contaminnated food - primary from
contaminated annimal products - eggs - salmonella disease of hens. Secondary - from carrier or patients. Need of big innoculun 106-8 - spread by food where it can multiply
• Salmonellosis - enteritis - infection of colon, fever, nausea, vomiting, headaches. Dg.: Stool sample 3 x consecutively. Lactose negative colonies, biochemical identifiction. Serotyping by slide agglutination according to Kauffmann White scheme - epidemiological purposes (S. enteritidis, S. infantis, S. agona, S. kentucky…………………….)
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Salmonella typhi• Typhoid fevers - fever with deterioration - systemic disease -
penetration to lamina propria, lymphatic nodes, RES (multiplication in hepari - spread via bile vesicle to intestine - , spleen, bone marrow), blood - bakteraemia, exanthem - roseola, fever, headache. GIT symptomes not always present - perforation . Carriage of Salmonella.
• Dg. - sample of stool, repeated after stimulation by MgSO4. Typical lood of cultivation. Serotypisation by slide agglutination. Detection of antibodies Vidal reaction. Vi agglutintiona
• Th. - CMP• Salmonella paratyphi A, B, C - Typhus like, milder
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Shigella• 4 species - Sh. dysenteriae, Sh. flexneri, Sh. boydii, Sh. sonnei a
38 serotypes• Dysentheria - watery diarhoea with blood, often epidemic,
transmitted with contaminated hands. Surviving in water 6 months. Small infectious dosis - 200 bacteria. Disease of small intestine first withou invasion. Production of enterotoxin - invasion and destruction of epitel, ulcers formation - pus and blood in stool
• Dg. Based on biochemical activity - characteristics of cultivation - without smell, not gas, lactose negative. Serotype differenciation - slide agglutination
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Yersinia• 7 species - Y.pestis, Y. pseudotuberculosis, Y.
enterocolitica, + oportunistic Yersíniae
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Yersinia enterocolitica• Enterocolitis in colder environment, most activity in
22*C, food borne infection, diarrhoea, fever. Chronic disease - terminal ileum, mesenteritis immitation of appendicitis. Extraintestinal symptomes - arthritis, hepatitis, osteomyelitis -
• Dg. - cultivation or serology by agglutination in extraintestinal sy
• blood borne infection - bacteraemia and endotoxic shock (blood cans - cooled)
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Klebsiella
• G- rod with typical structure• Encapsulated– mucous look of colonies - increased
virulence, notmotile• Klebsiella pneumoniae – pneumonia in patients not able
to clean from bronchial stroma and lungs the aspirate Necrotic destrukction of alveols. Bloody sputum. Infection of tissue and urinary tract
• K. rhinoscleromatis - sclerom• K. ozaenae – atrofic disease of nose musous membrane
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Proteus
• Motile G- rod, Rauss phenomen
• P. mirabilis – infections of urinary tract, production of ureasea ( lysis of urea, alcalinisation, increased possibility for calculli formation, toxicity for epitelium
• Proteus vulgaris
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Ostatné Enterobacteriaceae• G-, okrem Klebsielly bičíkaté – pohyblivé, niektoré opúzdrené,
virulencia závisí často na prítomnosti pili – prichytenie – testovanie hemaglutináciou
• Koliformné baktérie – E.coli, Klebsiella, Serratia Citrobacter a Proteus, Providencia- oportunistické patogény
• Enterálne infekcie – pri porušení eubiózy a premnožení• Nozokomiálne infekcie – močového traktu, chirurgických rán,
krvi a pľúc. • Infekcie v komunite – močové, infekcie při močových
kameňoch….• U imunokompromitovaných , po ATB, iné ochoreie, katetrizácia
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Laboratory diagnostic• growing well on non selective media• Selective media for detection of pathogens - lactose negative strains
Salmonella, Shigella• Biochemical identification – Hajn medium, Enterotests – group of
biochemical tests• Serodiagnosis – detection of antigenic structure – Salmonella, Shigella, E.coli• Interpretation of results – in
stool sample – Salmonella, Shigella, Yersinia – pathogens, other enterobacteriaceae – according the the state of eubiosis, when overgrowth - from physiologically sterile materials: urine – UTI, ascendent infection, blood – most improtant etiological agens, wounds, sputum – in monoculture, nose and throat sample - monoculture
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• Endotoxin - aktivita sídli v časti lipid A, uvoľnený po lýze bb., príčina systémových manifestácií
• Púzdro - K antigén, zábrana fagocytózy ( hydrofilný kapsulárny Ag proti hydrofóbnym fagocytom), zakrýva antigény bb. steny (bráni naviazaniu protilátok proti stenovým ag), slabý imunogén, slabý aktivátor C´. Zábrana baktericídnej aktivity séra
• Antigénne variácie - genetická expresia antigénov môže zlyhať, antigény sa nevytvoria, protilátky nemajú s čím reagovať.
• Tvorba exotoxínov - shiga, shiga-like = AB toxiny, hemolyzíny, termostabilné a termolabilné enterotoxíny
• Adhezíny - fimbrie (P fimbire, S fimbrie,,,,,)• Intracelulárne prežívanie• Vychytávanie železa - tvorbou vlastných kompetitívnych Fe vychytávajúcich
zlúčenín, uvoľňovanie Fe z hostiteľskej bunky hemolýzou
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Vibrionaceae• G- curved rods aerobe and anaerobe growth. Present in water• Oxidase test – posit. – diff. Dg from Enterobakteriaceae• V.cholerae - gastroenteritis• V. parahaemolyticus - gastroenteritis• V. vulnificans – bakteraemia, infection of wound, celullitis –
exposition to contaminated water, GIT – row sea fruits• V. alginolyticus – infection of wound and soft tissue, otitis externa• Other vibrias – infection of wound and moderate GIT infections• Plesiomonas – GIT infections from raw sea fruits• Aeromonas – opportunistic (…pijavice, after microsurgery)
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V. cholerae• Growing in 18* - 37*C• Serologically – 6 groups based on O antigen (patogennic are O1)• Vibrio cholerae O1 – 2 biotypes – el tor a cholerae and each present in
2 serologic subgroupes – ogawa a inaba• Adherence, not invasive. • Production of AB toxin – cholera enterotoxin – binding on specific
receptors of intestin, causing secretion of Na, K a bicarbonate to lumen – liquid lost - 1 liter in hr. (hypovolaemia, arythmia, kidney insufficiency). Not adhering bacteria are avirulentné
• In waters of Asia, human carriage and sea annimals. Spread by contaminated water and food. Necessity of big innoculum – 103-5. Less in condition of patients achlorhydria ( 104 bacteria after bicarbonate)
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Diagnosis and therapy of Vibrio• Microscopy – small, motile – native smear or darkfield• Cultivation – selective media – not supporting acid
environment and drying– enriche alkalin buillon pH 8,6• Dif. dg. V. cholerae a other vibiras
(halofile, requiring 1%NaCl)• Therapia V. cholerae – ATB for debacilisation only,
exotoxinu. (TTC,ERY, CMP, COT)., symptomatic - solution replacement V. parahemolyticus – mild disease, would infection – ATB – TTC)
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CampylobacterComma shape, G-, motile, 11 species,7 subspeciesRequiring microaerophil defined environment, 42*C, passing
through bacterial filters - selective isoloation Campylobacter jejuni – gastroenteritis in patients with decreased
immunity –hypogamaglobulinemia, decreased acidity of stomac liquid. Infection of epitel of jejunum, ileum and colon results in oedematous , bloody mucus with abscess formation.Infiltration to lamina propria. Enterotoxin, cytopatic toxin, endotoxin. Poultry, food neutralising pH reduced infection dosis.
C.coli - gastroenteritis, C. fetus – septicaemia, artritis, trombophlebitis, meningitis
Lab dg.: cultivation on selective media, microscopy - of stool - leu, antigen detection, Th.: ERY
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campylobacter
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Helicobacter• Spiral rods, G-, in connection with gastritis, gastric and
duodenal ulcer, susp.Ca – Gastrospirillum hominis• Pathogenesis – production of urease – formation of cloud
of NH4, that protects bacteria from acid in stomac - motility - mucinase formation – spread to mucous layer - adherence – attachment to intracelular junction – inflamation with mononuclear infiltration in lamina propria.Escape to IgA specific antibodies because of its location in mucous layer
• Interhuman transmission• Th. ATB . Bismuth, nitroimidasol a amoxicilin or TTC
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Laboratory diagnosis• Biopsy taken during endoscopy: Microscopy –
hematoxylin eosin staining, Gram staaining. ! Desinfection and contamination of endoscopic devices
• Detection of alkalic metabolits of urease activity. Rapid testt – 1-2 hrs – from bioptic material or breath test
• Cultivation - from bioptic material – enrichee media – blood, haemin, charcoal - problems: activity of inhibition caused by desinfection of endoscopes
• Serology: Detection of IgA ! Interpretation – prolonged presence not discriminating between acute and pass infection.
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helicobacter