THE UNIVERSITY OF DODOMA

SCHOOL OF NURSING AND PUBLIC HEALTH.

PROGRAM: BACHELOR OF SCIENCE IN CLINICAL NUTRITION AND
DIETETICS
COURSE NAME: FOOD MICROBIOLOGY
COURSE CODE: MD 221
COURSE INSTRUCTOR: Dr. MONGI and Dr. MANG’OMBE
NATURE OF WORK: GROUP ASSIGNMENT
GROUP NO: CND2 07
 PARTICIPANTS
NAME REGISTRATION NO.
ZAHARA AHMED NATINGWA T22-03-14280
MUSSA JOHN KASELA T22-03-04268
IRENE ABDALLAHKANYAMBO T22-03-06474
JUDITH NNKO T21-03-01782
EMMANUEL MASIGE T21-03-14374
WARIDI LUOGA T22-03-14808
YOHANA DOHHO TSERE T22-03-07051
ELIA WILCKRIPH KIULA T22-03-00090
BRYSON BATON NGADANGO T21-03-14657
LUCY J. KIZENGA T21-03-04749
TOPIC TO BE DISCUSSED
DICUSS ENTEROBACTERIAE IN RELATION TO FOOD MICROBIOLOGY
INTRODUCTION
• Enterobacteria belong to the family Enterobacteriaceae.
The family has about 20 genera and 100 species, the commonest genera being:
• Escherichia
• Klebsiella
• Salmonella
• Proteus
• Shigella
• Yersinia
• Enterobacter and
• Citrobacter
CONT..
COMMON BIOLOGICAL CHARACTERISTICS
• They share most of the following characteristics:
• Gram-negative short rods,
• aerobic and facultative anaerobic,
• oxidase negative,
• grow on bile-containing media,
• attack sugars fermentative,
• ferment glucose with acid only or with acid and gas, and
• Reduce nitrate to nitrite.
CONT..
THEIR ECOLOGY
• Most of them are found in the GIT as normal flora, except Salmonella,
Shigella and Yersinia,
• They usually do not cause diseases in the GIT but may contribute to
normal GIT function and nutrition.
• Some of them may also be found in the URT and genital tract as
normal flora.
• They may also be found in the environment polluted by human
excreta.
CONT..
THEIR ANTIGENIC STRUCTURE
• Enterobacteria have 3 main groups of antigens called O (somatic), H (flagella) and K
(capsular).
O antigens:
• found in the cell wall
• are polysaccharide in nature
• relatively resistant to heat and alcohol treatment
• mainly detected by agglutination tests
• antibodies against them are predominantly IgM
• tend to cause agglutination in granular masses
• a single bacterium may carry several different O antigens,
• may be shared by different genera of enterobacteria
INTRO CONT..
THEIR ANTIGENIC STRUCTURE CONT..
H antigens:
• located in the flagella
• protein in nature
• relatively weak to heat and alcohol treatment
• may be preserved by treating motile bacteria with formalin
• detected by agglutination tests
• antibodies against them are mainly IgG
• cause agglutination in fluffy clumps
INTRO CONT..
• THEIR ANTIGENIC STRUCTURE CONT..
K antigens:
• found in capsules of capsulated bacteria
• most of them are polysaccharides
• associated with virulence
• Some enterobacteria possess pill (fimbriae), which are also associated
with virulence.
INTRO CONT…
• ANTIGENIC STRUCTURE PICTURE
INTRO CONT…
THEIR PATHOGENICITY
• Cause a wide range of diseases, most of which are opportunistic infections, e.g.:
• intestinal infections
• typhoid
• UTI
• food poisoning
• wound infections
• septicemia
• ear infections,
• meningitis and
• hospital acquired infections.
INTRO CONT…
• THEIR PATHOGENICITY CONT…
• All enterobacteria should be considered as potentially pathogenic as
they all release LPSs as they die which may cause endotoxic shock.
• Capsules contribute to their pathogenicity.
• Shigella dysenteries type 1 and some strains of E. coli may produce
exotoxins (enterotoxins).
INTRO CONT…
THEIR GROWTH CHARACTERISTICS
• Usually grow very easily in very many media used in the laboratory.
• Most of them are fast growers.
• Because of their non-fastidiousness and their abundance,
enterobacteria are a group of bacteria which have been most studied.

• MacConkey is one of the selective media for them.

• Selenite F and tetrathionate broths are enrichment media for
Salmonella and Shigella.
INTRO CONT…
THEIR GROWTH CHARACTERISTICS CONT…
• Shigella-salmonella agar medium is a selective medium for the two
bacteria.
• Rapid lactose fermenters: E. coli, Klebsiella spp, Enterobacter
aerogenes
• Slow lactose fermenters: Citrobacter
• Non-lactose fermenters: Salmonella, Shigella, Proteus
• Motile enterobacteria: E. coli, Enterobacter, Proteus, Salmonella
• Non-motile enterobacteria: Shigella, Klebsiella, Yersinia pestis
 SALMONELLA
• Salmonella is a genus of bacteria that can cause food poisoning in
humans, resulting in symptoms like diarrhea, fever, and abdominal
cramps.
• The bacteria are typically found in raw or undercooked foods, such as
eggs, poultry, meat, and unpasteurized dairy products.
The growth conditions for salmonella
• The growth conditions for Salmonella bacteria are influenced by
several factors, including temperature, pH, moisture, oxygen
availability, and nutrient availability.
 Explanation of these growth conditions
Temperature
• Salmonella bacteria thrive in temperatures ranging from 7°C to 47°C (44.6°F
to 116.6°F), with the optimum growth temperature typically between 35°C
and 37°C (95°F and 98.6°F). Temperatures outside this range can slow down
or inhibit bacterial growth.
• However, some strains of Salmonella, known as psychrotrophic strains, can
survive and even grow at refrigeration temperatures, posing a risk of
foodborne illness if contaminated food is not adequately stored or cooked
pH
• The pH level of the environment also influences Salmonella growth.
• The bacteria prefer a slightly acidic to neutral pH range of 6.0 to 7.5.
• However, they can tolerate a wider pH range, from about 4.0 to 9.0,
although growth may be slower or inhibited at extreme pH levels.
Cont.….
Moisture
• Salmonella bacteria require a certain level of moisture to grow and multiply.
• While they can survive in dry conditions for some time, they thrive in moist
environments.
• Foods with high water activity, such as raw meat, poultry, eggs, and dairy products,
provide an ideal habitat for Salmonella growth if proper hygiene and storage practices
are not followed.
Oxygen availability
• Salmonella bacteria are facultative anaerobes, meaning they can grow in both the
presence and absence of oxygen.
• However, they typically grow best under aerobic conditions (with oxygen).
• In anaerobic conditions (without oxygen), growth may be slower, but Salmonella can still
survive and reproduce.
Cont.….
Nutrient availability
• Like all bacteria, Salmonella require nutrients to grow and reproduce.
• They can utilize a variety of organic compounds, including carbohydrates,
proteins, and lipids, as energy sources and building blocks for cellular
processes.
• Food items that are rich in nutrients and have been contaminated with
Salmonella can support bacterial growth if not properly handled, cooked, or
stored.
• Understanding these growth conditions is essential for preventing
Salmonella contamination and foodborne illness.
• Proper food handling, storage, cooking, and sanitation practices can help
minimize the risk of Salmonella infection and ensure food safety.
 Pathogenic potential for salmonella

• The pathogenic potential of Salmonella refers to its ability to cause disease

in humans and animals.
• Salmonella species are known for their pathogenicity, primarily causing
gastroenteritis, although they can also lead to more severe systemic
infections in certain cases.
Explanation of Salmonella's pathogenic potential
• Invasion and Colonization: Salmonella enterica, the species most
commonly associated with human illness, has evolved mechanisms to
invade and colonize the gastrointestinal tract.
• Upon ingestion of contaminated food or water, Salmonella bacteria pass
through the stomach and reach the small intestine, where they adhere to
the intestinal epithelial cells and invade the mucosal lining.
Cont.…
Survival and Multiplication
• Once inside the host, Salmonella can survive and multiply within host
cells, including epithelial cells and macrophages.
• The bacteria utilize various virulence factors, such as adhesins, invasins,
and secretion systems, to evade host immune defenses and establish
infection.
Inflammatory Response
• Salmonella infection triggers an inflammatory response in the host,
characterized by the release of pro-inflammatory cytokines, chemokines,
and other immune mediators.
• This inflammatory cascade contributes to the symptoms of gastroenteritis,
including diarrhea, abdominal pain, fever, and vomiting
Cont….
Systemic Spread
• In some cases, particularly in immunocompromised individuals or
those with underlying health conditions, Salmonella infection can
spread beyond the gastrointestinal tract and cause systemic illness.
• This can lead to severe complications such as bacteremia (presence of
bacteria in the bloodstream), septicemia, meningitis, and focal
infections in various organs.
Cont….
• Variability in Virulence: Not all strains of Salmonella exhibit the same
level of virulence.
• The pathogenic potential of a particular strain can vary depending on
factors such as serotype, genotype, presence of specific virulence
genes, and host susceptibility factors.
• Certain serotypes, such as Salmonella Typhi and Salmonella Paratyphi,
are associated with typhoid fever, a systemic illness characterized by
prolonged fever, gastrointestinal symptoms, and potentially life-
threatening complications.
Transmission of salmonella

• Salmonella bacteria can be transmitted through various routes, primarily

through the ingestion of contaminated food, water, or contact with
infected animals or their environment.
Here are the main modes of transmission:
Foodborne Transmission:
• Consuming contaminated food is the most common route of Salmonella
transmission.
• Foods of animal origin, such as raw or undercooked meat, poultry, eggs,
and dairy products, are frequent sources of contamination.
• Additionally, fruits, vegetables, and other produce can become
contaminated through contact with contaminated soil, water, or
surfaces during cultivation, processing, or distribution.
Cont.….
Waterborne Transmission
• Contaminated water can serve as a vehicle for Salmonella transmission, particularly
in settings where water sources are contaminated with fecal matter containing the
bacteria.
• Drinking untreated or inadequately treated water, swimming in contaminated
recreational water, or consuming beverages made with contaminated water can lead
to infection.
Direct Contact
• Direct contact with infected animals, their feces, or environments contaminated with
Salmonella can result in transmission.
• This is especially relevant in settings such as farms, petting zoos, and animal handling
facilities where close contact with animals occurs.
• Salmonella can also be transmitted from person to person through fecal-oral route,
particularly in households or healthcare settings.
Cont.…..
Cross-Contamination
• Cross-contamination can occur when Salmonella bacteria from raw or
contaminated foods come into contact with surfaces, utensils, or other foods
that are not properly cleaned or separated.
• Improper food handling practices, such as using the same cutting board or knife
for raw meat and ready-to-eat foods, can facilitate the spread of bacteria.
Vector-Borne Transmission
• Certain insects, such as flies and cockroaches, can act as mechanical vectors for
Salmonella transmission by carrying the bacteria on their bodies and
transferring them to food or surfaces.
• Although less common, this mode of transmission can contribute to the spread
of infection in certain environments.
Cont.…..
Antibiotics resistance
• Antibiotic resistance is a significant concern in the context of
Salmonella infections and public health.
• Over time, Salmonella bacteria can develop resistance to antibiotics,
making treatment more challenging and increasing the risk of severe
illness and complications.
Antibiotic resistance in Salmonella
• Mechanisms of Resistance: Salmonella can acquire antibiotic
resistance through various mechanisms, including:
Cont.…
• Mutation: Spontaneous mutations in bacterial genes can confer
resistance to certain antibiotics.
• Horizontal Gene Transfer: Salmonella can acquire resistance genes from
other bacteria through mechanisms such as conjugation, transformation,
and transduction
• Efflux Pumps: Salmonella may produce efflux pumps that actively
remove antibiotics from the bacterial cell, reducing their effectiveness.
• Enzymatic Inactivation: Some Salmonella strains produce enzymes that
chemically modify or degrade antibiotics, rendering them ineffective.
Cont.….
Antibiotic Classes: Salmonella can develop resistance to multiple
classes of antibiotics, including:
• Fluoroquinolones
• Cephalosporins
• Aminoglycosides
• Tetracyclines
• Sulfonamides
• Beta-lactams
Cont.…
• Public Health Implications: Antibiotic-resistant Salmonella infections can
lead to prolonged illness, increased healthcare costs, treatment failures,
and higher rates of morbidity and mortality, particularly in vulnerable
populations such as the elderly, immunocompromised individuals, and
young children. In severe cases, infections may progress to systemic
illness, requiring hospitalization and intravenous antibiotics.
• Food Safety Concerns: Antibiotic-resistant Salmonella strains can
contaminate food products, posing a risk to consumers. Resistant bacteria
may enter the food supply through infected animals, contaminated water,
or cross-contamination during food processing and handling.
Consumption of contaminated foods can lead to human infections with
antibiotic-resistant strains, complicating treatment and control efforts.
Cont.….
• Detection methods
• Several methods are used for the detection of Salmonella in various
samples, including food, water, environmental surfaces, and clinical
specimens. Here are some common detection methods:
• Culture-based methods: Culture-based methods involve isolating and
cultivating Salmonella bacteria from samples. This typically includes:
• Enrichment: Samples are incubated in selective enrichment broths that
promote the growth of Salmonella while inhibiting the growth of other
bacteria.
• Selective plating: After enrichment, samples are plated onto selective
agar media containing specific nutrients and inhibitors to selectively
isolate Salmonella colonies based on their biochemical characteristics.
Cont.…
• Biochemical tests: Isolated colonies are subjected to biochemical tests
(e.g., biochemical reactions, serotyping) to confirm their identity as
Salmonella.
• Molecular methods: Molecular methods detect Salmonella DNA or RNA
sequences directly from samples. These methods offer rapid and
sensitive detection and include:
• Polymerase chain reaction (PCR): PCR amplifies specific regions of
Salmonella DNA using targeted primers, allowing for the rapid
detection of the bacteria.
• Real-time PCR (qPCR): qPCR enables quantitative detection of
Salmonella DNA in real-time, providing information on the bacterial
load present in the sample.
Cont.…
• Loop-mediated isothermal amplification (LAMP): LAMP is an isothermal
amplification technique that amplifies DNA under constant temperature
conditions, making it suitable for rapid and field-based detection of
Salmonella
• Immunological methods: Immunological methods detect Salmonella
antigens or antibodies in samples. These methods include:
• Enzyme-linked immunosorbent assay (ELISA): ELISA detects specific
Salmonella antigens or antibodies using antigen-antibody interactions
and enzyme-mediated colorimetric or fluorescent detection.
• Lateral flow immunoassay: Lateral flow assays provide rapid and
qualitative detection of Salmonella antigens in samples, with results
visible as colored lines on a test strip.
Cont.….
• Prevention
• Preventing Salmonella infections requires a multi-faceted approach
that addresses various stages of the food production chain, as well as
personal hygiene and public health measures. Here are key strategies
for preventing Salmonella infections:
• Food Safety Practices: Implementing proper food handling,
preparation, and storage practices can minimize the risk of Salmonella
contamination in food products. This includes:
• Cooking foods, especially meat, poultry, and eggs, to safe
temperatures (e.g., poultry to at least 165°F/74°C) to kill any
Salmonella bacteria present
Cont.….
• Avoiding cross-contamination by keeping raw foods separate from
ready-to-eat foods, using separate cutting boards and utensils for raw
and cooked foods, and washing hands and surfaces thoroughly after
handling raw foods.
• Refrigerating perishable foods promptly and maintaining proper
refrigeration temperatures to slow bacterial growth.
• Avoiding consuming raw or undercooked eggs, unpasteurized dairy
products, and raw or undercooked sprouts, which can be sources of
Salmonella contamination.
Cont.….
• Good Hygiene Practices: Practicing good personal hygiene can reduce
the risk of Salmonella transmission. This includes:
• Washing hands with soap and water before and after handling food,
after using the restroom, and after contact with animals.
• Ensuring proper handwashing techniques, including lathering with
soap for at least 20 seconds and rinsing thoroughly.
• Teaching children proper handwashing habits and supervising them to
ensure compliance.
Cont.….
• Safe Water and Environmental Practices: Ensuring the safety of water
sources and maintaining hygienic environmental conditions can
prevent Salmonella contamination. This includes:
• Using clean, safe water for drinking, cooking, and food preparation.
• Implementing proper sanitation practices in food production facilities,
agricultural settings, and food service establishments to prevent
contamination of food and water sources.
• Properly managing animal waste and ensuring proper disposal to
prevent environmental contamination.
Cont.….
• Public Health Measures: Public health authorities play a critical role in
preventing and controlling Salmonella infections through:
• Surveillance and monitoring of Salmonella outbreaks and trends to
identify sources of contamination and implement control measures.
• Education and outreach efforts to raise awareness about Salmonella
infection risks and preventive measures among the general public,
food handlers, healthcare providers, and other stakeholders.
Cant…..
• Collaboration with regulatory agencies, industry partners, and
international organizations to develop and implement policies,
regulations, and guidelines aimed at reducing Salmonella
contamination and improving food safety.
• By implementing these preventive measures at the individual,
community, and regulatory levels, the incidence of Salmonella
infections can be reduced, protecting public health and enhancing
food safety.
SHIGELLA

• Shigella is the most important agent of bacillary dysentery. They are

nonmotile and does not ferment most of sugars except mannitol.
• Based on combination of biochemical and serological characteristics, shigellae
are classified into four species which are S.dysenterie, S.flexneri, S.boydii and
S.sonnei which are designated as serogroups A, B, C and D respectively.
Important Properties Shigellae are non–lactose-fermenting, gram-negative rods
that can be distinguished from salmonellae by three criteria:
• They produce no gas from the fermentation of glucose,
• They do not produce H2S
• They are non-motile
SHIGELLA CONT…
• All shigellae have O antigens (polysaccharide) in their cell walls, and
these antigens are used to divide the genus into four groups: A, B, C,
and D.
SHIGELLA CONT…
Pathogenesis & Epidemiology Shigellae are the most effective pathogens
among the enteric bacteria.
• They have a very low ID50, Ingestion of as few as 100 organisms causes
disease, whereas at least 105 V. cholerae or Salmonella organisms are
required to produce symptoms.
• Shigellosis is only a human disease (i.e., there is no animal reservoir).
• The organism is transmitted by the fecal–oral route. The four Fs, fingers,
flies, food, and feces are the principal factors in transmission. Foodborne
outbreaks outnumber waterborne outbreaks by 2 to 1.
• Outbreaks occur in day care nurseries and in mental hospitals, where fecal–
oral transmission is likely to occur.
CONT…
• Children younger than 10 years account for approximately half of
Shigella-positive stool cultures. There is no prolonged carrier state
with Shigella infections, unlike that seen with S. typhi infections.
Shigellae, which cause disease almost exclusively in the
gastrointestinal tract, produce bloody diarrhea (dysentery) by
invading the cells of the mucosa of the distal ileum and colon.
• Local inflammation accompanied by ulceration occurs, but the
organisms rarely penetrate through the wall or enter the
bloodstream, unlike salmonellae. Although some strains produce an
enterotoxin (called Shiga toxin), invasion is the critical factor in
pathogenesis.
CONT…
• The evidence for this is that mutants that fail to produce enterotoxin
but are invasive can still cause disease, whereas noninvasive mutants
are nonpathogenic. Shiga toxins are encoded by lysogenic
bacteriophages.
• Shiga toxins very similar to those produced by Shigella are produced
by enter hemorrhagic E. coli O157:H7 strains that cause enterocolitis
and HUS
SHIGELLA CONT…
LABORATORY DIAGNOSIS SHIGELLAE
• Form non–lactose-fermenting (colorless) colonies on MacConkey’s or EMB agar.
• On TSI agar, they cause an alkaline slant and an acid butt, with no gas and no H2S.
• Confirmation of the organism as Shigella and determination of its group are done
by slide agglutination.
• One important adjunct to laboratory diagnosis is a methylene blue stain of a fecal
sample to determine whether neutrophils are present.
• If they are found, an invasive organism such as Shigella, Salmonella, or
Campylobacter is involved rather than a toxin-producing organism such as V.
cholerae, E. coli, or Clostridium perfringens. (Certain viruses also cause diarrhea
without neutrophils in the stool.)
SHIGELLA CONT…
TREATMENT
• The main treatment for shigellosis is fluid and electrolyte
replacement.
• In mild cases, no antibiotics are indicated.
• In severe cases, a fluoroquinolone (e.g. Ciprofloxacin) is the drug of
choice, but the incidence of plasmids conveying multiple drug
resistance is high enough that antibiotic sensitivity tests must be
performed.
• Trimethoprim-sulfamethoxazole is an alternative choice.
E COLI

• Escherichia coli is the only medically important species in the genus

Escherichia, It is found around the ano-genital area as a normal flora.
SPECIFIC FEATURES OF ESCHELICHIA COLI
• It is a Gram-negative motile rod
• It is a lactose-fermenter with acid and gas formation
• Ferments sugars with acid and gas formation
• It is Indole positive
• It grows very easily in many commonly used media
E.COLI CONT…
ETIOLOGY
• E.Coli causes a diarrheal diseases caused by diarrhoeagenic strains of E coli.
• These diarrhoagenic strains are differentiated on the basis of pathogenic mechanisms and they
include:
(a) Enteropathogenic E. coli (EPEC) strains
• Cause diarrhea by intimately adhering to host cell membranes in the small bowel and thereby
causing loss of microvilli (effacement), the diarrhea caused by these strains is watery and is
particularly common among infants.
(b) Shiga toxin producing E. coli (STEC) strains
• Produce an enterotoxin called verotoxin, which is very similar to the Shiga toxin produced by Shigella
dysenteriae type 1.
• The diarrhea tends to be bloody and is a form of food poisoning,
• One complication of this type of diarrhea is hemolytic uremic syndrome that is characterized by acute
renal failure.
CONT…
(c) Enteroinvasive E. coli (EIEC) strains
• Produce diarrhea by causing invasion of the intestinal mucosal epithelial cells,
just like Shigella spp do.
(d) Enteroaggregative E. coli (EAEC) strains
• Cause diarrhea by a mechanism not well understood, the diarrhea may be
acute or chronic they aggregate or adhere to human cells.
(e) Enterotoxigenic E. coli (ETEC) strains
• Cause diarrhea by producing an enterotoxin that is very similar to that
produced by Vibrio cholera.
• The ETEC strains are common causes of traveler’s diarrhea and the diarrhea is
a form of food poisoning.
E.COLI CONT…
TRANSMISSION OF E.COLI INFECTION
• The E.Coli disease infections is usually acquired by the consumption
of contaminated food or water with this bacteria (FECAL-ORAL-
ROUTE)
E.COLI CONT…
SYMPTOMS OF E.COLI INFECTIONS
• Profuse watery diarrhoea with mucous but no blood (unless it is the
invasive form)
• Fever
• The onset is acute and progress rapidly to severe diarrhoea
• The fluid balance in children is more easily disturbed than in adults
because of rapid fluid turnover
• Dehydration rapidly occurs and may be severe
• Abdominal disturbance/ pain to a dysentery-like disease,vomiting
E.COLI CONT…
PREVENTION AND CONTROL FOR E.COLI INFECTION
• For infants prevent low birth weight and prematurity by improving
antenatal care.
• Prevent malnutrition in weaning period and continue breast feeding
in the second year and avoid bottle feeding.
• Controls of diarrhoeal diseases (CDD) programmes are now an active
part of child survival in health ministries of several countries in Africa.
PREVENTION AND CONTROL FOR E.COLI INFECTION
CONT..

The activities included in these programs are:

• Oral rehydration solution (ORS) to reduce diarrhea-related deaths
• Improvement of water and sanitation to reduce transmission and
number of episodes of diarrhea
• Immunization
• Sustained breastfeeding
• Antenatal care to reduce low birth weight
• Practice good hand washing after using the toilet, before preparing
food, before eating, anytime hands get soiled or touch any stool.
 YERSINIA

• They are short, pleomorphic gram-negative rods that can exhibit bipolar
staining.
• They are catalase positive, oxidase negative, and microaerophilic or
facultatively anaerobic.
• Most have animals as their natural hosts, but they can produce serious
disease in humans.
• Th e genus Yersinia includes Yersinia pestis, the cause of plague; Yersinia
pseudotuberculosis and Yersinia enterocolitica, important causes of human
diarrheal diseases; and several others considered nonpathogenic for humans.
• Several species of Pasteurella are primarily animal pathogens but can also
produce human disease
Cont……
• Yersinia species , particularly yersinia pestis responsible for causing plaque, yersinia
enterocolitica,yersinia pseudotuberculosis have significant pathogenic potential.
• They can cause various disease ranging from gastrointestinal infection to systemic infection like
the bubonic plaque.
Pathogenesis and Pathology
• When a fl ea feeds on a rodent infected with Y pestis , the ingested organisms multiply in the
gut of the fl ea and, helped by the coagulase, block its proventriculus so that no food can pass
through.
• Subsequently, the “blocked” and hungry fl ea bites ferociously, and the aspirated blood,
contaminated with Y pestis from the fl ea, is regurgitated into the bite wound.
• Th e inoculated organisms may be phagocytosed by polymorphonuclear cells and macrophages.
• Th e Y pestis organisms are killed by the polymorphonuclear cells but multiply in the
macrophages; because the bacteria are multiplying at 37°C
 Cont……

• they produce the antiphagocytic protein and subsequently are able to resist
phagocytosis.

• Th e pathogens rapidly reach the lymphatics, and an intense hemorrhagic

inflammation develops in the enlarged lymph nodes, which may undergo necrosis
and become fluctuant.
• Although . Hemorrhagic and necrotic lesions may develop in all organs;
meningitis, pneumonia, and serosanguineous pleuropericarditis are prominent
features.
• Primary pneumonic plague results from inhalation of infective droplets (usually
from a coughing patient), and it is characterized by hemorrhagic consolidation,
sepsis, and death.
PATHOGENIC POTENTIAL
• Yersinia species , particularly yersinia pestis responsible for causing plaque,
yersinia enterocolitica,yersinia pseudotuberculosis have significant pathogenic
potential.
• They can cause various disease ranging from gastrointestinal infection to systemic
infection like the bubonic plaque.athogenesis and Pathology .When a fl ea feeds
on a rodent infected with Y pestis , the ingested organisms multiply in the gut of
the fl ea and, helped by the coagulase, block its proventriculus so that no food can
pass through. Subsequently, the “blocked” and hungry fl ea bites ferociously, and
the aspirated blood, contaminated with Y pestis from the fl ea, is regurgitated into
the bite wound. Th e inoculated organisms may be phagocytosed by
polymorphonuclear cells and macrophages. Th e Y pestis organisms are killed by
the polymorphonuclear cells but multiply in the macrophages; because the
bacteria are multiplying at 37°C,
 Cont……
• they produce the antiphagocytic protein and subsequently are able to
resist phagocytosis. Th e pathogens rapidly reach the lymphatics, and
an intense hemorrhagic inflammation develops in the enlarged lymph
nodes, which may undergo necrosis and become fluctuant. Although
the invasion may stop there, Y pestis organisms often reach the
bloodstream and become widely disseminated. Hemorrhagic and
necrotic lesions may develop in all organs; meningitis, pneumonia, and
serosanguineous pleuropericarditis are prominent features.Primary
pneumonic plague results from inhalation of infective droplets (usually
from a coughing patient), and it is characterized by hemorrhagic
consolidation, sepsis, and death.
 Growth condition

• Yersinia species typically thrive in mesophilic conditions,meaning they grow

best in moderate temperature condition around in 25-37 °C.They can grow in
wide range environments including intestine of animals and human as well as in
soil ,water and food .• Yersinia species are zoonotic pathogens that cause
disease in humans ranging from mild gastrointestinalinfectionsto serious
diseases with high mortality such as plague.
 Transmission
• Plague is an infection of wild rodents transmitted from one rodent to
another and occasionally from rodents to humans by the bites of
fleas. Serious infection oft en results, which in previous centuries
produced pandemics of “black death” with millions of fatalities. Th e
ability of this organism to be transmitted by aerosol and the severity
and high mortality associated with pneumonic plague make Y pestis a
potential biological weapon. The control of plague requires surveys of
infected animals, vectors, and human contacts; in the United States,
this is done by county and state agencies with support from the
Plague Branch of the CDC and by destruction of plagueinfected
animals
 Cont …..
• If a human case is diagnosed, health authorities must be notified
promptly. All patients with suspected plague should be isolated,
particularly if pulmonary involvement has not been ruled out. All
specimens must be treated with extreme caution. Contacts of
patients with suspected plague pneumonia should receive doxycycline
as chemoprophylaxis.
 ANTIGENIC RESISTANCE
• Yersinia species have shown the ability to develop resistance to antibiotics over
time.This resistance can vary depending on the strain and geographic location.It's crucial
for health care providers to monitor antibiotics resistance patterns and use appropriate
antibiotics for treatment.All yersiniae possess lipopolysaccharides that have endotoxic
activity when released. Th e three pathogenic species produce antigens and toxins that
act as virulence factors. They have type III secretion systems that consist of a
membrane-spanning complex that allows the bacteria to inject proteins directly into
cytoplasm of the host cells. Th e virulent yersiniae produce V and W antigens, which are
encoded by genes on a plasmid of approximately 70 kb. Th is is essential for virulence;
the V and W antigens yield the requirement for calcium for growth at 37°C. Compared
with the other pathogenic yersiniae, Y pestis has gained additional plasmids. pPCP1 is a
9.5 kb plasmid that contains genes that yield plasminogen-activating protease that has
temperaturedependent coagulase activity (20°–28°C, the temperature of the fl ea) and fi
brinolytic activity (35°–37°C, the temperature of the host)
 Cont….
• Th is factor is involved in dissemination of the organism from the fl ea
biteinjection site. Th e pFra/pMT plasmid (80–101 kb) encodes
capsular protein (fraction F1) that is produced mainly at 37°C and
confers antiphagocytic properties. In addition, this plasmid contains
genes that encode phospholipase D, which is required for organism
survival in the fl ea midgut. Th e three pathogenic yersiniae have a
pathogenicity island (PAI) that encodes for an iron-scavenging
siderophore yersiniabactin. Among several exotoxins produced, one
is lethal for mice in amounts of 1 µg. Th is homogeneous protein
(molecular weight, 74,000) produces β-adrenergic blockade and is
cardiotoxic in animals. Its role in human infection is unknown.
 Regulatory guidelines

• Yersinia regulatory guidelines vary depending on countries and regions

Prevention and ControlContact with farm and domestic animals, their feces,
or materials contaminated by them probably accounts for most human
infections. Meat and dairy products have occasionally been indicated as
sources of infection, and group outbreaks have been traced to contaminated
food or drink. Conventional sanitary precautions are probably helpful. There
are no specific preventive measures.Treatment most Yersinia infections with
diarrhea are selflimited, and the possible benefits of antimicrobial therapy
are unknown. Y enterocolitica is generally susceptible to aminoglycosides,
chloramphenicol, tetracycline, trimethoprimsulfamethoxazole, piperacillin,
thirdgeneration cephalosporins, and fluoroquinolones; it is typically
resistant to ampicillin and to firstgeneration cephalosporins.
 Cont…..
• Proved Yersinia sepsis or meningitis has a high mortality rate, but
deaths occur mainly in immunocompromised patients. Yersinia sepsis
can be successfully treated with third-generation cephalosporins
(possibly in combination with an aminoglycoside) or a
fluoroquinolone (possibly in combination with another antimicrobial).
In cases in which clinical manifestations strongly point to either
appendicitis or mesenteric adenitis, surgical exploration has been the
rule unless several simultaneous cases indicate that Yersinia infection
is likely.
 Clinical finding
• The clinical manifestations of plague depend on the route of exposure.
After an incubation period of 27 days, there is high fever and painful
lymphadenopathy, commonly with greatly enlarged, tender nodes (buboes)
in the neck, groin, or axillae. This is the bubonic form of the disease.
Vomiting and diarrhea may develop with the early septicemic form of
disease. Later, disseminated intravascular coagulation leads to hypotension,
altered mental status, and renal and cardiac failure. Terminally, signs of
pneumonia and meningitis can appear, and Y pestis multiplies
intravascularly and can be seen in blood smears. Primary pneumonic plague
results from direct inhalation of organism into the lung. Patients often have
a fulminant course with chest pain, cough, hemoptysis, and severe
respiratory distress.
 Yersinia Enterocolitica And
pseudoTuberculosis
• These are nonlactosefermenting gramnegative rods that are urease positive and oxidase
negative. They grow best at 25°C and are motile at 25°C but nonmotile at 37°C. They are
found in the intestinal tracts of a variety of animals, in which they may cause disease, and are
transmissible to humans, in whom they can produce a variety of clinical syndromes.Y
enterocolitica exists in more than 70 serotypes; most isolates from human disease belong to
serotypes O:3, O:8, and O:9. There are striking geographic differences in the distribution of Y
enterocolitica serotypes. Y pseudotuberculosis exists in at least six serotypes, but serotype
O:1 accounts for most human infections. Y enterocolitica can produce a heat-stable
enterotoxin, but the role of this toxin in diarrhea associated with infection is not well
defined.Y enterocolitica has been isolated from rodents and domestic animals (eg, sheep,
cattle, swine, dogs, and cats) and waters contaminated by them. Transmission to humans
probably occurs by contamination of food, drink, or fomites. Y pseudotuberculosis occurs in
domestic and farm animals and birds, which excrete the organisms in feces. Human infection
probably results from ingestion of materials contaminated with animal feces. Person-to-
person transmission with either of these organisms is probably rare.
PATHOGENESIS AND CLINICAL
FINDINGS
• Yersiniae must enter the alimentary tract to produce infection. During the incubation
period of 47 days, yersiniae multiply in the gut mucosa, particularly the ileum. This leads
to inflammation and ulceration, and leukocytes appear in feces. The process may extend
to mesenteric lymph nodes and, rarely, to bacteremia.Early symptoms include fever,
abdominal pain, and diarrhea. Diarrhea ranges from watery to bloody and may be caused
by an enterotoxin or to invasion of the mucosa. At times, the abdominal pain is severe
and located in the right lower quadrant, suggesting appendicitis (more common with Y
pseudotuberculosis). One to 2 weeks after onset, some patients with histocompatibility
antigen HLA-B 27 develop arthralgia, arthritis, and erythema nodosum, suggesting an
immunologic reaction to the infection. Very rarely, Yersiniainfection produces
pneumonia, meningitis, or sepsis; in most cases, it is self-limited.Yenterocolitica has also
been associated with transfusion-related infections caused by contaminated red blood
cells. This is a consequence of the ability of the organism, transmitted by an
asymptomatic donor, to multiply at refrigeration temperatures.
Detection methods
• Diagnostic Laboratory Tests,Plague should be suspected in febrile
patients who have been exposed to rodents in known endemic areas.
Rapid recognition and laboratory confirmation of the disease are
essential to institute lifesaving therapy which are:
 Cont……
• 1;Specimens
• Blood is taken for culture and aspirates of enlarged lymph nodes for
smear and culture. Acute and convalescent sera may be examined for
antibody levels. In pneumonia, sputum is cultured; in possible
meningitis, cerebrospinal fluid is taken for smear and
culture.Specimens may be stool, blood, or material obtained at
surgical exploration. Stained smears are not contributory.
Cont…
• 2;Smears
• Y pestis are small gram negative bacilli that appear as single cells or as pairs or
short chains in clinical material. Wright, Giemsa, or Wayson stains may be more
useful when staining material from a suspected buboe or a positive blood culture
result because of the striking bipolar appearance (safety pin shape) of the
organism using these stains that is not evident on a direct Gram stain. More
specific direct staining methods (possibly available through reference
laboratories) include the use of fluorescent antibody stains targeting the capsular
F1 antigen. vectors, and human contacts; in the United States, this is done by
county and state agencies with support from the Plague Branch of the CDC and by
destruction of plagueinfected animals. If a human case is diagnosed, health
authorities must be notified promptly. All patients with suspected plague should
be isolated.
Cont…..
• 3; Culture
• All materials are cultured on blood agar, chocolate, and MacConkey agar plates and in brainheart
infusion broth. Growth on solid media may be slow, requiring more than 48 hours, but blood culture
results are often positive in 24 hours. Cultures can be tentatively identified by biochemical reactions. Y
pestis produces nonlactosefermenting colonies on MacConkey agar, and it grows better at 25°C than at
37°C. The organism is catalase positive; indole, oxidase, urease negative; and nonmotile. The last two
reactions are useful in differentiating Y pestis from other pathogenic yersiniae. An organism with these
characteristics should be referred to a public health laboratory for more confirmatory testing. Definite
identification of cultures is best done by immunofluorescence or by lysis by a specific Y pestis
bacteriophage (confirmation available through state health department laboratories and by consultation
with the Centers for Disease Control and Prevention [CDC], Plague Branch, Fort Collins, CO).All cultures
are highly infectious and must be handled with extreme caution inside a biological safety
cabinet.identification of cultures is best done by immunofluorescence or by lysis by a specific Y pestis
bacteriophage (confirmation available through state health department laboratories and by consultation
with the Centers for Disease Control and Prevention [CDC], Plague Branch, Fort Collins, CO).All cultures
are highly infectious and must be handled with extreme caution inside a biological safety cabinet.
Cont….
• 4;Serology
• In patients who have not been previously vaccinated, a convalescent
serum antibody titer of 1:16 or greater is presumptive evidence of Y
pestis infection. A titer rise in two sequential specimens confirms the
serologic diagnosis.In paired serum specimens taken 2 or more weeks
apart, a rise in agglutinating antibodies can be shown; however,cross-
reactions between yersiniae and other organisms (vibrios,
salmonellae, and brucellae) may confuse the results.
ENTEROBACTERIACEAE
CONCLUSION
• The Enterobacteriaceae microbial ecology of soil and water is
extremely complex. Sewage, systems, animal excreta, manure,
contaminated agricultural products, etc can result in the
contamination of soil and freshwater sources with enteric bacilli.
• The pathogenic enterobacteria released into soil may not simply
colonize resident plants transiently but may develop a longer-term
relationship with them as alternative hosts.
• Plants could then act as hosts for enteric species when existing as
aquatic vegetation in freshwater habitats, including lakes, rivers and
ponds.
CONCLUSION CONT..
• To cut off the cycle soil and water that harbor the enterobactericeae
should be managed through environmental sanitation, water
treatment, and proper utilization of latrines to ensure environmental
safety.
• Raw and uncooked food should be properly handled before
consuming or cleaned before refrigeration.
• If the enterobacteria already infected human, proper medication
should be used that permanently eradicate the infection thus stop the
cycle of infection.
References

• Cook, G., & Zumla, A. (2003). Manson’s Tropical Diseases, (21 st ed.).
London: Saunders.
• Kingondu, T. et al, (2007). Communicable Diseases. (2008). Nairobi :
AMREF
• .Warren Levinson MD,PhD Review of Medical Microbiology and
Immunology 13th Edition (2014)