1. Non-coliform lactose-negative, Yersinia, Pasteurella, and Haemophilus 2008274060 서경진 ( 자료정리 ) 2008274034 위정화 ( 요약, Quiz) 2008274061 이유민 (PPT) 2008253023 윤숙경 (PPT) 2008274048 심유진 ( 발표 ) 2007251127 이지은 ( 발표 )

2. Contents Tribe Proteeae Salmonella Shigella Yersinia Pasteurella Haemophilus Quiz

3. Proteus Salmonella Shigella Noncoliform Lactose – Negative enterics

4. Tribe Proteeae Genus Proteus Opportunist wavelike swarming pattern HS(+), Urease(+) Urinary tract infection, Wound infection Septicemia, Infant diarrhea

5. Tribe Proteeae Genus Morganella M. morganii less 20% DNA homology with other proteeae Genus Providencia Prov. stuartii, Prov. rettgeri, Prov. Stuartii nosocomial infection

6. Genus Salmonella General Characteristics Primary pathogens Gram(-) bacilli Facultative anaerobe, opportunist Flagella, Not fastidious Catalase(+), Oxidase(-) H 2 S(+), Gas(+) except S. Typhi

7. Virulent factors Surface O Ags of S.typhi - Formation of specific O side chain Toxins - Endotoxin : major role, the fecer(42˚C) - Enterotoxin : Properties of both LT and ST of E.coli Intracellular survival

8. Typoid Fever S. Typhi Contaminated food and water, person-to-person contact asymptomatic carriers Ab production in 2~3 weeks Lifelong immunity after recovery

9. Typoid Fever fever, diarrhea, abdominal pain Diagnosis - Patient's history - Resenting symptoms - Rising antibody titer - Isolation of bacteria

10. Typoid Fever Prevention - Isolation from contaminated source - Vaccines : oral amoxicillin

11. Typoid Fever Treatment -prevention of dehydration and electrolytes imbalance - Antimicrobial : Chloramphenicol, Sulfa-trimethoprim - Surgical treatment : Cholecystectomy

12. Animal Salmonelloses normal intestinal flora in cattle, poultry, rodents Zoonotic in origin - S. Enteritidis, S. Paratyphi A S. Paratyphi B, S. Paratyphi C unpasteurized fresh, -> inherent risks Enteric fever, Gastroenteritis

13. Genus Shigella General Characteristics Gram(-) bacilli Primary pathogens absence of flagella Facultative anaerobe, Opportunist H 2 S(-) except Sh. flexneri Urease(-), Fastidious Sh. Dysenteriae, Sh. flexneri,Sh. Boydii, Sh. sonnei

14. Virulent factors Smooth Lipopolysaccharides : O Ag - Formation of specific O side chain - Smooth colony : virulent - Loss of plasmids : Rough type - Cell adhensiveness Endotoxin - cause fever

15. Virulent factors Enterotoxin - Inflammation of the underlying gut wall layer - Degeneration of the villi, -local erosion -> bleeding, heavy mucous secretion Shiga-Toxin - Heat-labile exotoxin(Sh. dysenteriae ) - Injury to nerve cells and nerves Damage to the intestine

16. Shigella Dysentery crippling abdominal cramps, frequent defecation of watery stool Epidemiology - Human being only host - Person-to-person oral acquisition - Long-term asymptomatic carriage state - Highly communicable -Low infective dose (200 bacilli)

17. Shigella Dysentery Pathogenesis - Initial implantation - Later implantation - Shigella septicemia (Shiga toxin effect) - Spontaneous cure in healthy adults - High mortality in children

18. Shigella Dysentery Diagnosis - Through fresh specimen of feces - Serological typing - Biochemical characterization Treatment –Severe care of dehydration –Antibiotic therapy

19. Yersinia Paseurella Haemophilus

20. The enteric Yersinia Noneneric Yersinia

21. Oxidase (-) Yersinia Family Enterobacteriaceae Genus Yersinia Zoonotic infections The Enteric Yersinia Y. Enterocolitica Y. Pseudotuberculosis The Enteric Yersinia Y. Enterocolitica Y. Pseudotuberculosis Nonenteric Yersinia Y. pestis Nonenteric Yersinia Y. pestis

22. The enteric Yersinia Y. enterocolitica Y. pseudotuberculosis :intestinal inhabitants of wild and domestic animals → enteric infections in humans

23. The enteric Yersinia Y. enterocolitica Gram negative rods Facultative anaerobes Virulence factors are temperature sensitive Gram negative rods Facultative anaerobes Virulence factors are temperature sensitive Y. pseudotuberculosis More benign than Y. enterocolitica Lymph node inflammation More benign than Y. enterocolitica Lymph node inflammation

24. Nonenteric Yersinia pestis Gram (–) rod Bipolar staining Capsules (+) Facultative anaerobes Spore & flagella (–) Pandemics of plague Zoonotic disease

26. Virulence Factors Capsular and envelope proteins : protect against phagocytosis foster intracellular growth Coagulase : clots blood → obstructing blood vessels in human → clogging the esophagus in fleas Endotoxin & intracellular murine toxin

27. The Complex Epidemiology Humans can develop plague : Through contact with wild animals (Sylvatic plague) : Domestic or semidomestic animals, or infected humans (Urban plague)

28. Y. Pestis 감염경로 The animal reservoirs - endemic reservoirs, amplifying hosts - Endemic reservoirs : harbor the organism but do not develop the disease ex) rodents (mice, voles)

29. Y. Pestis 감염경로 Amplifying host : become infected, massive die-offs during epidemics spread the disease to other mammals ex) brown rats, ground squirrel, wood rat, black rat, chipmunk, rabbit → sources of human plague

30. Y. Pestis 감염경로 Flea vectors :in the transmission of the plague bacillus from reservoir hosts to amplifying hosts to humans are fleas.

31. Flea vectors The esophagus becomes blocked → unable to feed → ravenous flea jumps from animal to animal → regurgitated infectious material into the bite wound

32. Flea vectors Tiny blood sucking insects, the bacilli multiply in its gut Not host specific, feed on other species Fleas of rodents : vectors in human plague By human flea, by handling infected animal skins or meat

34. Y. pestis 발생부위 Bubonic plague: necrosis, swelling of lymph nodes (groin, axilla) Septicemic plague: DIC -> hemorrhage -> necrosis -> “Black death” Pneumonic plague: hemoptysis -> death

35. Y. pestis Diagnosis The patient’s history (recent travel to endemic regions) Culture of bubo aspirate Death as quickly as 2 to 4 days after the appearance of symptoms

36. Treatment & Prevention Streptomycin, Tetracycline, Chloramphenicol Quarantine during epidemics, trapping and poisoning rodent Vaccine -Killed vaccine : effective only for a few month - Attenuated vaccine : more effective but also has more side effects

37. Oxidase(+) Nonenteric Pathogens Pasteurella spp. Haemophilus spp.

38. Pasteurella spp. Normal flora in animals Facultative anaerobes Gram (-) rods Bipolar staining

39. Pasteurella multocida Normal flora in animals Zoonotic infection Opportunistic infections

40. Poultry & wild fowl : cholera-like outbreaks Cattle : outbreaks of hemorrhagic septicemia or pneumonia “shipping fever” Cats & dogs : nasopharynx, tonsils

41. Pasteurella infactions Animal bites or scratches → localized cellulitis → lymphadenitis Systemic infection in immunocompromised patients. (liver cirrhosis or rheumatoid arthritis)

42. Haemophilus spp. Tiny, gram (-) rods Filamentous, spherical bodies Fastidious & sensitive to dry, temp., disinfectants Blood loving factor X (hemin) factor V(NAD or NADP)

43. Nonvirulent & Virulent Nonvirulent species : normal colonist of the upper respiratory tract or vagina Virulent species H. influenzae H. aegyptius ( conjunctivitis ) H. ducreyi ( chancroid ) H. parainfluenzae ( childhood meningitis ), H. aphrophilus

44. Haemophilus influenzae Isolated from patients with ‘flu’, but the causative agent → influenza virus Acute bacterial meningitis - By the ‘b’ serotype, children ( 3 months ~ 5 years )

45. Haemophilus meningitis Not associated with epidemics, but sporadic cases or cluster in daycare & family settings Very similar symptom to meningococcal meningitis

46. Haemophilus infections Transmitted by close contact, nose & throat discharges Healthy adult carriers : reservoirs of the bacillus Untreated cases : fatality rate is 90%

47. Haemophilus aegyptius Koch - Weeks bacillus Diseases : acute communicable ‘conjunctivitis’(pinkeye) In children, by contaminated fingers & shared personal items Treatment : antibiotic eyedrops

48. Haemophilus ducreyi Diseases : chancroid ( soft chancre ) : STD In the tropics & subtropics, mostly males Treatment : cotrimoxazole

49. H. parainfluenzae & H. aphrophilus Normal oral & nasopharyngeal flora Diseases : infective endocarditis in adults (underlying congenital or rheumatic heart disease) Periodontal disease, oral injury

50. Q & A

51. 1. Salmonella Typhi 에 대한 설명이 아닌 것은 ? ① Vi 항원은 협막항원을 말한다. ② Typhoid fever 이 나타난다. ③ flagella 가 없어서 motility(-) 이다. ④ Gram(-), Catalase(+)

52. 2. Shigella 에 대한 설명이 아닌 것은 ? ① Shiga toxin 은 exotoxin 이다. ② 이에 속하는 모든 종이 H2S(+) 이다. ③ food, flies, feces 에 의하여 전파된다. ④ 이질은 복통, 설사를 일으킨다. ⑤ Salmonella 와 구분되는 점은 motility 이다.

53. 3. Y.pestis 에 대한 설명이 아닌 것은 ? ① 극염색성을 보이며 enteric agent 이다. ② 벼룩이 한 설치류 숙주에서 다른 숙주로 Y.pestis 를 전달한다. ③ 사람에게 감영되면 bubonic plaque, pticemic plaque, pneumonic plaque 가 나타난다. ④ 흑사병 (black death) 을 일으킨다. ⑤ 쥐, 다람쥐 등의 설치류의 병원체이다.

54. 4.Haemophilus 에 대한 연결이 아닌 것은 ? ① 형태 - cocobacilli ② X 인자 - hemin ③ V 인자 - NAD, NADP ④ 배지 - chocolate agar, blood agar

55. 5. swarming pattern( 유주현상 ) 을 일으키는 것은 ? ① S.aureus ② E.coli ③ Salmonella ④ Morganella ⑤ Proteus

56. Reference - Microbiology 제 5 판 / Kathleen Park Talaro / Mc Graw Hill / p.609-617 - Prescott 의 핵심미생물학 제 1 판 / 교보문고 / p.486-492 - 미생물학 제 7 판 / 라이프 사이언스 / p.537-540 - 신 종합미생물학 제 3 판 / 신일북스 / p.34 - 임상미생물학실습 개정 제 4 판 / 고려의학 / p.213-219, p.221-231, p.259-267 - 미생물 / 월드 사이언스 / p.309 - Brock 의 미생물학 제 12 판 / 바이오 사이언스 / p.423-426