oh i see let's start once again our lecturer for the family enterobacter are or is composed of three parts now una i have already discussed in the posted the recorded lecture for the biochemical tests for enterobac so hopefully in a panorama now you'll record the lecture in ion important it will give you an idea of how to distinguish differentiate and identify the different members of entire bacteria make sure that you will be watching it no please please write down also important side notes number two will be this part opportunistic and their associated infections and the number the are the pathologic members of enterobacter so part b mu natal opportunistic enterobacteriaceae and their associated infections so let's start the opportunistic members of enterobacteriaceae are composed of several genes so the first and the most important is the genus particularly the species escherichia coli otherwise known as colon bacillus e coli was initially considered as a harmless member of the colon resident biota however it is now recognized as a very important human pathogen associated with many clinical syndromes like for example uti diarrheal disease and even central nervous system infections now please take note that escherichia once again is part of the normal bowel flora okay and the genital tract okay so two parts subtle one parts not in magica and escari please take note that this invades the entire site lining of the large intestines it is the leading cause of nosocomial infection and very importantly escherichia coli is used as the primary marker for fecal contamination in water quality testing that's why later on we will encounter esquiri chiaholi once again in our lecture for the microbiologic study and analysis of drinking water okay so once again this is used as a primary marker for fecal contamination of water quality testing in terms of antigenic determinants melancholic number one is the o antigen the o antigen is a heat stable heat stable antigen o this is found in the cell wall oh antigen number two is each antigen okay this is heat heat labile heat lab by found in the flagella okay number three is k antigen k antigen is also a heat la by polysaccharide it is polysaccharide that covers the o antigen pang apato indiana is the sex sex in common eli the sex and the common pillai is responsible for the attachment of the organism to epithelial surfaces now to epithelial surfaces now please take note your importance on an o in each antigen snapping this o and h antigens are useful in the identification of strains of e coli now particularly humongous strains with or associated with serious enteric or gastrointestinal diseases now on selective and differential media particularly in emb and maconti agar monte agar puyang e coli has a distinctive morphology on emb e coli will appear as green metallic shin colonies green metallic shin double metallic shin colonies okay like that okay while on mcconkie again antistick note colonies of e coli will appear pink piano will appear pink okay surrounded by an area of precipitated bile salts okay like what you can see here okay so figure a okay figure a this one shows us the typical dry lactose positive escherichia coli not growing on mcconkey agar and then please take note of the pink precipitate that surrounds the colonies so yeah that's the pink precipitate okay surrounding the pink colonies of escherite so being a lactose fermenter pink in positive shows us the colonies of e coli okay that are mucoid a mucoid colonies on mcconkey agar and then this one aman shows us the difference between strains that are lactose fermenters and yes there are strains that are non-lactose fermenters so pink surrounded by a pink uh or an area of precipitated bile salts okay are non-lactose fermenters so pink like the pink light colin and colonies next in terms of biochemical testing please take note that skd chia holi is a fermenter of many types of carbohydrates like glucose lactose rehalose and cylos in addition please take note it will not produce h2s it's negative for dnase udas or phenylalanine the amines that's why in psia okay tsa so a over a a negative for h2s but positive for gas next it's positive for indole it's positive for methyl red however negative four volts plus tower and it's negative for sight weight utilization test so with this okay the invic reaction in the reaction of escherichia holy opacity for indole positive for mr methyl red but negative for vp and negative for site rate utilization okay please take note that e coli is associated with two um two types of pathology conditions no so una is the equalized strains that are associated with uropathogenic diseases like for example uti and the other group are those associated with gastrointestinal pathogenic diseases or gastrointestinal illnesses young strain that is associated with eudopathogenic illnesses or particularly uti now please take note that e coli is widely recognized as the most common cause of utis in humans now the main vigilance of e coli deleted uti is pili okay eli please take note that this pili allows the euro pathogenic strains of e coli to adhere to epithelial cells epithelial cell lining and it will not be washed out with udin flow okay so in this assam the onsitudin flow because of eli okay additional factors contributing to the vigilance of euro pathogenic e coli are cytolysins and aerobactines now please take notepod and cytolysin is also is often characterized as a hemolysin hepaxin habinating hemolysin this can kill immune effector cells it can also inhibit phagocytosis and chemotaxis of certain wbcs this allow the bacterial cell to chill it ion again so cytolysins and aerobactines okay so the other pathogenic escherichia coli are those associated with gastrointestinal conditions or infections so under this melantarium lemon categories namely we have epec is now so please take note of the vidulence factor diarrhea h7 okay another question is the one associated with us or udemic syndrome okay h for ehec or hemoda is associated with has particularly young has this is a complication of okay so let's discuss each one of them one by one okay so the first is enterotoxigenic e coli or etec okay this is the primary cause of travelers diarrhea okay infant diarrhea watery diarrhea with vomiting cramps nausea and low grade fever by the way young travelers the infection can spread commonly by a consumption of contaminated food contaminated water predating for hygiene crediting new area consumption the potable water that you are using is an inadequately sanitized or poorly sanitized so most of the time the humanik hadon and genetoclasian infections are the travelers um in a foreign country or in a foreign place they are not accustomed with the delicacy okay or the practices of that place [Music] no in in a foreign country for example the post champion choice ngnaten is to eat consume [Music] [Music] okay so the clinical picture for enterotoxin e coli or ethic is in an bloody non-invasive a with watery diabetes tool or water spool and then please take note a main video and spo for enterotoxin is plasmid plasmid can be either heat labile or heat stable toxin and heat stable toxin unahi natin yung hit labyltoxin okay this is the heat labytoxin i hope you can see it young heat label toxin konatan is made up of two subunits so subunit a and subunits okay so it will put you mode of attachment autonomous you mean toxin now and upon importance in hitler by toxin please take note heat laby toxin activates adenylyl cyclase now what is the importance of adenylyl cyclase so please take note in the presence of atp adenylyl cyclase will now increase the secretion of camp or thumb now it will increase the secretion of camp andopo nc amp this stands for cyclic adenosine monophosphate now cyclic adenosine monophosphate and what will be the effects of cyclic adenosine monophosphate by the way cyclic adenosine monophosphate serves as a messenger within the cell outside of the cell information for the cell to take action okay about that particular event or happening outside of the cell okay so the net effects of the increased camp includes number one inhibition okay inhibition of sodium the absorption inhibition inhibition of sodium the absorption number two it will increase increase the secretion of fluoride kn potassium and other electrolytes okay so the net effects of camp is that it inhibits sodium the absorption and it increases the secretion of fluoride potassium and other electrolytes okay those are an importance effects in camp because of this now please take note water is being drawn outside of the cell into the lumen of the intestines so imagine that this is the lumen of the intestines so because of this imbalance in electrolytes the body member our in our electrolytes are important because they balances the fluid inside okay and outside of the cell inside and outside of the cell intracellular fluid and extracellular fluid so if there will now be imbalance in imbalance in the electrolytes macaron didn't imbalance between the fluid outside and inside of the cell okay so in this case no in the presence of enterotoxin e coli fluid in the lumen or outside of the cell that's why medong for the heat stable toxin it will activate one elite organic cyclase a this one okay and in the presence of gtp no gtp or um or guaniliza in the presence of gtp it will now increase no cgmp or cyclic guanosine monophosphate okay a cyclic guanosine monophosphate so a net effect is the same to that of c a and p increase inhibition of an inhibition of solution the absorption and then increase secretion of fluid potassium and other electrolytes so once again it will now draw water into the lumen okay causing watery stool or diabetes so interval equilibrium number two or is so this causes a second or this is the cause of this is the second most of the second most common cause of infantile diarrhea in underdeveloped countries a second most common cause of infantile diarrhea in underdeveloped countries and young number one number one cospo islata virus by the way the site of infection for epec is the small intestines no small intestines so the clinical picture of epec is swatted diarrhea with vomiting with non-blood stool and non-invasive non-invasive okay so the video lens for this is a plasmid okay plasmid mediated attachment resulting to an effacement no effacement of the microvilli then this will lead to mal absorption in diarrhea intestinal tract because of its plasmid it will now attach itself to the microvilli normal microvilli [Music] long projections okay however with the attachment of epic magazines or flattening flattening of the microvilli so this flattening or effacement of the microvilli will result in malabsorption okay mal absorption number three is interro invasive e coli entero invasive e coli or e please take note now the site of action is the large large intestines so this causes fever and operantine watery diarrhea and initially whatever diarrhea may progress to the center a followed by scan this containing blood and mucous this is also a plasmid mediated invasion okay this may lead to destruction of the epithelial cell lining of the colon which may lead to ulcer formation okay ulcer formation so what will happen here is that the organism okay it is or its mechanism is only its its mechanism is almost the same to that of shigella now so will you think of the organism okay we'll enter the enterocyte okay this one atendito and then inside it will be enclosed into a phagosome okay however it will be quite useless because the organism can escape healing it will be touched by a magma fudge however once again it can escape clean it it can escape killing okay so because of this the organism will infect other cells it will be transferred to other enterocytes or m cells causing cell destruction and cell death is invasive causes death of the enterocyte death of the cell destruction of the cell number four a number four is entered e-coli okay the site of action is the large intestines a large intestines this is considered a deadly e coli infection and the only non-sorbitol fermenter now the only non-sorbitol fermenter so please take note it causes initially whatever diarrhea and then followed by grossly bloody diarrhea with cramps but with little or no fever okay little or no fever now please take note one complication of ah a is hemolytic udemy syndrome or hus or haas so this is a condition in which the small blood vessels of our kidney snow becomes damaged and inflamed and this damage can cause clot formation in the vessel and then of course nato can clog the filtering capabilities or the filtering system of our kidneys that's why mejor delete on complication at all because it may lead to kidney failure and it can be life-threatening by the way the mode of transmission is by consumption of contaminated hamburger so i have included this and support examination and i know what type of gastrointestinal pathogenic e coli okay is acquired through the consumption of contaminated hamburgers a person can acquire the infection through consumption of uncooked meat or the milk now from an infected source or infected animal or infected cattle okay we can also acquire through fruit and vegetables they contaminated with the organism a bucket because droppings of contaminated animals find their way into the water bodies okay or sources of water and in turn feed the soil contaminating fruits and vegetables incubation period major mobilist three to eat this and signs and symptoms once again stomach muscle spasms diarrhea fever and vomiting or death vapor is about 3 to 5 and lastly number five is center aggregative entero aggregative e coli the site of infection is the small intestines this causes infant diarrhea with water spool or water stool and vomiting sign and symptom signs and symptoms includes dehydration and low grade fever so once again the vidal inspector for this is plasmid okay where there is plasmid mediated aggregative adherence of flux now shortening the length of the microvilli so once it's once it reaches the intestinal lumen okay and then as a group they will now adhere to the microvilli you know they will adhere to the microvilli in fact they will even and with this now the organism can release its cytotoxins and enterotoxins while at the same time shortening the microvilli affecting the normal functions of the microvilli so entero aggregative e coli the following are other notable species of escherichia the first one is escherichia germany with yellow pigmented organism or colonies mostly isolated from the csf wounds in blood the escherichia vulneras are isolated from human with infected wounds while escaritia alberti are associated with diabetes in children so the picture below shows us the comparison between escarique volneris and esquedicia germany so this is on mcconkie agar please take note now young esquedice is not that well distinct he compared okay compared once again to eskeri okay so those are the species of esquiri no um associated with gastrointestinal infection okay the second most important member of this group is the genus climbsella okay in particular okay the most important species of climb shella is clebsi is otherwise known as friedlanders bacillus so this will have similar biochemical characteristics with enterobacter a biochemical characteristics includes tsia of a over a h2s negative in weak reaction of negnet passpass it's non-motile now actually differentiates it no easily to other members of the family so it is a uds producer ud is positive the vigilance factor is capsule that's why on culture the organism will produce colonies that are mucoid and glistening another test to the to to detect the presence of climate is by using or doing neo-filled te lang test a work up solar swelling test i another one is string test in a string test so on mcconkie agar he has a lactose fermenter obviously will just spin colonies okay pink colonies on microscopic study please take note okay you will observe capsule by surrounding the cell positive for swelling the man no reaction or capsular swelling test like that yeah you get the colonies or you get the growth on mcconkie agar and then use a steady inoculating loop and then try to touch no the surface of the colonies with the loop of the inoculating loop and then raise it like that and a positive string test will show a string no one end attached to the inoculating loop one end still not attached to the colony and length and length is usually about two about one to two centimeters indicating a positive strength indicating a mucoid colony with a capsule the condition the condition associated with glibcella neumonie is loboranium labor pneumonia is otherwise known as community or hospital acquired pneumonia so this is an extensive necrotizing consolidation of the lungs symptoms includes current jelly-like sputum so imagine patanjali is not um once again this is a a board exam question redisposing factors includes alcoholism okay people who are immune compromised or with compromised pulmonary functions and cystic pulmonary conditions risk technology can also cause uti bacteremia and meningitis okay the following are other species of shelling money first is oxytoca okay with a past snake pass pass no a invic reaction it is also indole positive i will have the same infection that of libshell shell animony a number two is klebsiella ozani now which causes atrophic diabetes characterized by feudal and sinus infection number three is klebsiella by no scleromatis particularly of the nose and the other farings no nose and the other fadings number four is klebsiella granulomatism so it causes granuloma inguinale otherwise known as donovanuses okay so this is a type of chronic genital ulcerative disease that can be transmitted sexually or non-sexually now please take note that libsella granulomatis will not grow in artificial cultural media hence young diagnosis neto is made by gate is made by getting samples no from infected lesion and then staining them with gems or light stain okay so i know to look for the condition or the infection we need to observe mononuclear mono nuclear cells with at least one to 25 bacteria okay 1 to 25 bacteria indicating the presence of donovan sis the third genera third genus in this group is the enterobacter species there are several species know of enterobacter antelope dr klovashay and antelobacter erogenous they are the two most common isolates from this group so they are isolated from wound from urine from blood and csf while enterobacter agglomerants are the cause of outbreaks of septicemia resulting from contaminated intravenous fluid while entering bacteria gel joviae are found in respiratory samples and are rarely isolated from blood cultures now in terms of biochemical characteristics now please take note that members of enterobacter are motile okay the colony morphology of many of the species of enterobacter may dissemble clemsella especially when growing on mcconkie agar okay however species of enterobacter no are negative for methyl red a while positive for rogues poscowar so enterobacter species the next genus are the seratia species members of this genus are known to be opportunistic pathogens most of them are associated with outbreaks in health care they are known to be slow or late fermenters and they are known to produce prodigiousin prodigiousin is a type of pigment pink to the dunkulenyan now produced by members of sedasha with environmental origins the two most common isolates are cerasia marcescens and seratia odorifera sebastromercescence is the most important and significant clinical species of sriracha so this causes hospital acquired infection and urinary and respiratory tract infection bacteremia outbreaks in nurseries okay and cardiac surgery in burn and burn units it's also known as a contaminant of antiseptic solution okay while while sebastia ordo di feranaman emits dirty musty odor not assembling that in potito and has two bio groups in bio group 1 is isolated from respiratory tract young biographer is isolated from blood and csf some main difference is that in bio group 1 is positive for both sucrose and or nitin while negative no man for both humble group okay so species the next genus is hafnia so please take note that hafnia is composed of one species only isalanian which is half nia alve however hafnia alve has two distinct biotypes and then in parallel is this one hapnia alve biotype one the hafnia alve biotype one which is isolated or grows in beerworld in bruvidis and it has not been isolated clinically apnea alveoli has been linked to gastroenteritis and isolated from stool culture the major feature of this is its delayed positive citrate reaction a delayed positive citrate reaction apnea biotype okay the next is proteus or proteus by allah way of saying its name so produce is a genus isolated from urine no wounds here and bacteria condition in fact um um species are known to be responsible for about three percent of all hospital acquired infections in the united states particularly utis there are several species of protein use however one of the most important is produce mirabilis proteus metabolism is a known cause of struvite kidney stone condition it is associated with uti in fact no this particular organism can ascend the udinavitra okay meaning to say it can cause infections in both the lower part okay or the lower urinary tract in the upper udinabi track it can even which know the proximal convoluted tubules okay pattern part uh after glomerulus basically this can can cause also acute glomerulonephritis glomerulonephritis is a condition and um a condition of the filtering capabilities of our kidneys nothing okay so once again this can lead to slow white kidney stones or urinal calcium in tagalog one unique picture of proteus mirabilis is that it can produce warming colonies on on non-selective media okay young swarming colonies is a coordinated surface movement of the bacteria so for example so angry is outwards my uniformity has a coordinated movement yeah and with these types of colonies another unique picture is it's odor it's smell okay the colonies will have a burnt chocolate order okay burnt chocolate or door now to differentiate proteus metabolism from proteus vulgaris okay we can perform indole an or anything test in which mirabilis is positive in indole but negative in ornithine vulgarista man is negative in indole but positive in or anything so proteus mirabilis in proteus vulgaris the next is morganella now please take note that the genus morganella has only one species now which is more ganela morgani the role of this organism or its disease association has been recorded okay as you didn't have attack infection okay it has also been identified as echoes of neonatal sepsis this take note its important feature is that it is motile no motile however unlike proteus it is not swarming it do not uh it does not swarm coordinated movement the next is providencia okay has several important species okay one of which is providentia story know which is the cause of outbreaks in berlin units it can also be isolated from european culture okay together with providence geri they are isolated from from immune compromised patients okay while uh while providencia alkali fashions are commonly isolated from feces of children with diarrhea okay it has also been implicated in diarrheal disease among travelers or travelers disease so this is 80 table showing us the differentiating characteristics of the selected species of what they use providencia and morganella so see whether you can take along a print screen of this so these are the tests okay or biochemical tests in the different species of proteus providencia and morganella and lastly so these are the other notable species number one is edward cielatarda you the yeast or eurea negative lysine the carboxyl is positive it is also h2s and indole positive and can cause bacteremia in wound infection eruvinia is more of a plant pathogen identification is more for academic interest than clinical and lastly cytobacter funding psychobacter cytobacter flundi can cause nosocomial infection as well as endocarditis among drug users okay so its colonies are are h2s producers it can be mistaken for salmonella now especially when isolated from school culture okay so and biochemical tests nagina go and attempt to differentiate these two is the hydrolysis of urea now we're in cyto cytobacter fundi um is you the positive or ud is positive okay while salmonella is negative okay so these are the uh the organisms now that composes or comprises the opportunistic members of the family in terror bacteria so any questions or clarifications