Lec 1. Salmonella Typhi, Entric Fever and Brucella PDF

Microbiology 1: Salmonella typhi, Entric fever and Brucella Prof. Hazem Aqel Blood and Lympha6c System Basic Medical Sciences Al-Balqa Applied University  Objectives t Macrophage arram...

Microbiology 1: Salmonella typhi, Entric fever and Brucella Prof. Hazem Aqel Blood and Lympha6c System Basic Medical Sciences Al-Balqa Applied University  Objectives t Macrophage arram gallbladonic correct Mane - Describe the morphology and the structure. Describe growth and toxins many typhi -> Explain pathogenesis and clinical disease spots &capsule -> Rose Explain mode of transmissions. Hamon / Explain the clinical manifesta6ons. Be familiar with the laboratory diagnosis. Hsitive L S Be familiar with treatment and preven6on. vaccine Diarrhea ·estable in Salmone lla typhi, Enteric Fever  MORPHOLOGY · gram ove Gram stain nega6ve bacilli (rods). These are seen as single pairs and chains. These are mo6le. These are aerobic. glucose Non-lactose fermenter. nee oxidase · testove -3.5 Produce H S gas. 4 2 Salmonella, Hess8 Brutius Their capsules consist of SI, -> antiphagocytic polysaccharides. pathogenic, capsule -IS, These are mo6le with Magella.  Colonies are gray and can grow on ordinary media (blood agar). Selec6ve media are: :58.1555bb/ stool J, Salmonella is i Culture may be taken from the feces. media 53; 3,5 ij - si lactosesi. MacConkey agar = pale non-lactose : non-actose Is -> lactose Is is. I fermen6ng colonies. - Snon-lactose lactose & pinkish color or Desoxycholate citrate agar = pale non- Brownid Is fermenter lactose fermen6ng colonies. GROWTH nonlactose & colorless iss fermenter Xylose-lysine desoxycholate agar = observe for red colonies with a black center. Wilson and Blair’s bismuth sulUte agar = observe black metallic colonies due to H2S produc6on. $55,51 Selenite F and tetrathionate broth for. ysd59.1581 - enrichment, then subculture to - macConkey (4.8 MacConkey agar.  HaS production (516) prutius $4,341; 195's? six fevers, I- typhoid P ratie e I winess [ -155.5358 Salmonella confirm saimonella is urines. typhoid UTI 85. typhoid fever fever tribe sugariron -> ser test aglutination - Salmonella * Has production & Growth and biochemical characteris6cs of Salmonella enterica subsp. enterica serovar Typhi. (A) Growth on Hektoen enteric agar (non-lactose fermenter, slight H2S produc6on). (B) Serological reac6vity to Remel Wellcolex Color Salmonella test reagents 1 (top: green agglu6na6on with red background = serogroup D) and 2 (boZom: red agglu6na6on with blue ssisdisis colony background = Vi an6gen), consistent with S. typhi. (C) Growth on a triple sugar iron agar slant (K/A with slight H2S produc6on Representative culture media for Salmonella typhi Salmonella and shegilla gar a strains on: (a) XLD agar; (b) SS agar. -> Toxins ⑪ motility ② ③ ↓ phagocytic 0 anti (cellwalls antigen ↳  This is a sep6cemic disease caused by members of certain salmonella serovars. ENTERIC The commonest causa6ve agent of enteric Htyphoid fever) fever is Salmonella typhi. FEVER The clinical manifesta6ons caused by this bacterium are also called as typhoid fever and those due to S. paratyphi A and B as paratyphoid fever.  entric fever?-** (5) septisamic The primary mode of transmission of the typhoid bacillus is the fecal-oral route through contaminated food and water. The incuba6on period is usually 14 days but PATHOGENE may range between 5 to 20 days. SIS AND The organisms on entering the gastrointes6nal tract aZach to and penetrate the epithelial CLINICAL lining of the small intes6ne. Following penetra6on, the bacteria are FEATURES phagocy6zed by macrophages but are unfortunately not destroyed. because of capsule (antiphagocytic These organisms mul6ply within the macrophages. The macrophages carry these to the re6culoendothelial system. ss. · s s macrophage sid  fever - e maliase - pain aches v These events occur during the Urst week of ‫ٮﺎﻟﻌﺎدة‬1 ‫ٮوع‬1‫ٮﺄول اﺳ‬1 ‫ٮﺶ‬4‫ﺤ‬1‫ٮي‬1 ‫ﺣكﻰ اﻟﺪﻛ)ٮور اﻟﻤريﺾ‬ lethargy ~ infec6on and15 ‫ٮﺮ‬4‫ٮ‬B‫ٮﻜون اﻟﻤﺮض زاد ﻛ‬1 ‫ٮﺎﻟﺚ‬B‫ى واﻟ‬A‫ٮ‬D‫ٮﺎ‬B‫ٮﺎﻟ‬1 ‫ى‬A‫ح‬1‫ٮي‬1 ‫ﻣﺶ ﻣ)ٮﺄﻛﺪ اذا ﺻﺢ ﺣﻜﲖ‬ may be accompanied by fever, -1151 malaise, lethargy and aches and pains. Salmonellas s ==5& macrophage III 76455. During the second week extended bacteremia is present and the foci of infec6on may occur PATHOGENE in various 6ssues; oben the gallbladder becomes infected. SIS AND Bacteria may be shed from the gallbladder back into the intes6nal lumen. During this 6me CLINICAL ulcera6ve lesions of Peyer’s patches may develop, and the pa6ent is oben severely ill FEATURES with a constant fever as high as 40oC, abdominal tenderness, diarrhea or cons6pa6on, and vomi6ng. By the third week the pa6ent may be exhausted but s6ll be↳febrile.(- fatigue,exhusted Death may occur in 10% of untreated pa6ents. 1955s. 1  PATHOGENESIS AND CLINICAL FEATURES Aber recovery, mul6plica6on of these bacteria in the gallbladder has been seen in 3% of the pa6ents. These persons may become iss chronic carriers and serve as source of future outbreaks.  The typhoid fever may occur in endemic (residual) two epidemiological types. epidemic The Urst is the endemic or residual typhoid which occurs throughout the year and the other one is the PATHOGENESI epidemic typhoid fever which may occur in endemic or non-endemic S AND areas. This epidemic may be water, food CLINICAL or milk borne. Rarely the source of infec6on in an FEATURES epidemic may be shellUsh (dried or frozen), eggs, meats, and meat products, recrea6onal drugs such as marihuana, animal dyes such as carmine used in prepara6on of drugs, food and cosme6cs as well as household pets. * is-  Blood 1st week -> urine 2nd -> -> feces 3rd C LABORAT ORY Isola6on of Salmonella serotypes typhi or paratyphi from blood cultures (Urst week of ⑲ infec6on), urine ⑦ DIAGNOSI ⑬ (second week) or faeces (Urst week onwards). third Serology (Widal’s test) is now rarely performed, S because of unreliable results. (54 ⑤  The drug of choice is ciproMoxacin. Chloramphenicol is also efec6ve, but this may TREATMENT have serious side efects. Co-trimoxazole is also used and has less serious side efects than Chloramphenicol.  5- X care %100 The Hygienic measure like: Clean water supply. Adequate disposal of sewage material. Washing of the hands aber the defeca6on. The best is to wash your hands with soap at least three 6mes. Take care of food handling and processing. PREVENTIO For the carriers, give them treatment and advise them to wash their hands aber the N defec6on. Vaccina6on should be advised in the family with a history of enteric fever. Injectable vaccine. The oral vaccine is replacing the injectable vaccines. These are Vi capsular polysaccharides.  Arucellare fever undulant a Doxycyclin exhaution capsulated fever;I' olications - -> -> rifampin as primary treatment anuroticsate O muscular cow and articular[ pain pigs ↳ Brucellosis unpastrized diary products (milk)  MORPHOLOGY AND STRUCTURE See Rods Brucellae are small, non-mo6le bacilli, usually Salmonella, sis" coccobacillary in shape and range in size from 0.5 to 0.7 μm by 0.6 to 1.5 μm. Salmonellas; I These are arranged singly, some6mes in pairs, short chains or small clusters. The members of genus Brucella do not produce spores, or Magella. Salmonella; Capsules, when formed, are small and can be demonstrated only in smooth and mucoid variants. S These are gram-nega6ve but counterstain poorly and require longer 6me for uptake of stains. I I non pathogenic  mo is fustidius Brucellaes Brucellae are strict aerobes FA g;?8g's median s Br. abortus is a capnophilic, many strains ~ Brucellars" - FAS1> curbon 18 silss! Media se1(ix's requiring 5-10% CO2 for growth. & detoxification i FA Op6mum temperature is 37oC (range 20-40oC) CULTURAL and pH 6.6-7.4 Grow on simple media, through growth is slow CHARACTERI and scanty. STICS Growth is improved by the addi6on of serum or liver extract. The media employed currently are serum Brucenness.Simoneis,isnig X dextrose soy agar, serum potato infusion agar, tryp6case soy agar, or tryptose agar  CULTURAL CHARACTERISTI CS Antibiotic - f The addi6on of bacitracin, polymyxin Brucellness slowgrowth Antifungal I and cycloheximide to the above media :Ybac [$ n SIG makes them selec6ve. contamination- S8.) Esriistan,in 5. 9 Erythritol has a specially s6mula6ng efect on the growth of Brucellae. -58s s On solid media, colonies are small, moist, translucent and glistening aber 3 or more days of incuba6on. In liquid media growth is uniform.  Human infec6on may be of three types Latent infec6on: with only serological but PATHOGENE 6 si's. - IgG, IgM [asises no clinical evidence Acute or sub-acute brucellosis, and SIS acute is." iss Sub acute I 21519s · Chronic brucellosis -i 815  Acute Brucellosis is mostly due to B. melitensis. I Bracellusis, multfever, It is usually known as undulant fever, but this is misleading as only some cases show the undulant paZern. It is associated with prolonged bacteremia and ACUTE irregular fever. The symptomatology is varied, consis6ng of I BRUCELLOS glg acutes' muscular and--ar6cular pains, asthma6c aZacks, nocturnal drenching sweats, IS ! exhaus6on, anorexia, cons6pa6on, nervous irritability and chills. bone The usual complica6ons are ar6cular, osseous, s visceral or neurological. sine, Sub-acute brucellosis: it may fellow acute brucellosis. Blood culture is less frequently posi6ve. inf1% -51 subacute can'tdetect brucellae & * we - - -x! stum 8.  & gigf Le.- - - 58te, Sabrach Chronic brucellosis, which may be non- 3 Ds bacteremic, is a low-grade infec6on with periodic exacerba6ons. -> CHRONIC 5.42024. The symptoms are generally related to a state Tr?,.sisof 2hypersensi6vityS in the pa6ent. BRUCELLOS T cells gly) Common clinical manifesta6ons are swea6ng, IS [.5 lassitude and joint pains, with minimal or no Chronic pyrexia. siss - > The illness lasts for years MODE OF TRANSMISSIONS Percutaneous Oral entry: Aerosols: infec6on: Inges6on of ~ Inhala6on of Through skin contaminated animal bacteria. 5 abrasions or by products (oben raw Contamina6on of the accidental milk or its conjunc6vae. inocula6on. deriva6ves) 19,51 - w Contact with contaminated Ungers  for human, Justfor animals vaccine No monella is sic CLINICAL MANIFESTIONS Rose spots. I almonedas S. see sing ~ racute acute + chronic dacute ↑ Night Fever Malaise Anorexia sweats Weight Arthralgia Fa6gue Depression pain in joint. 1 loss 32645/ ↓ I acute cute  bac sysis- (i) A bitare 5 Specimen: blood, urine, sputum, - - - breast milk, lymph node biopsy and bone marrow aspirate. Laboratory methods for LABORATORY stivity $s8 is? diagnosis include: Culture DIAGNOSIS 8 bacteria S1,818S 855-81 bac si iG ·6181dD ESerologyI 95 55 1,3815 -> 2.1919. MicrobiologI test Microbiology 11-5 II & 15 931 Antibiotics highly resistance inf chronic Hypersensi6vity tests very expensive Molecular tes6ng => PCR,accurate very s9s se:sNed - :Iss. 1*  Doxycycline in combina6on with rifampin or gentamicin is the ess primary treatment for brucellosis. CiproMoxacin, and trimethoprim- sulfamethoxazole are also used in combina6ons. Although β-lactams may be ac6ve 5:20 in vitro, clinical response is poor, TREATMENT probably as a result of failure to penetrate the intracellular loca6on of the bacteria. The therapeu6c response is not rapid; 2 to 7 days may pass before pa6ents become afebrile. Up to 10% of pa6ents have relapses in the Urst 3 months aber there are therapy. No human vaccine is in use. animals justfor  Persons handling the animals should be use protec6ve clothing and gloves. Pasteuriza6on or boiling of milk should be done PREVENTION Vaccina6on: CaZle should be vaccinated with live aZenuated B. abortus strain 19, RB51 for cows. Unimmunized infected animals should be slaughtered. Is References Salmonella Cynthia Nau Cornelissen & Marcia Metzgar Hobbs: Lippinco1 Illustrated Reviews: Microbiology. 4th Edi6on. 2020. Wolters Kluwer. Pages: 118-120. Kenneth J. Ryan, Nafees Ahmed, J. Andrew Alspaugh, et al. : Sherris Medical Microbiology. 7th Edi6on. 2018. McGrow Hill Educa6on. Pages: 634-640 Brucella Cynthia Nau Cornelissen & Marcia Metzgar Hobbs: Lippinco1 Illustrated Reviews: Microbiology. 4th Edi6on. 2020. Wolters Kluwer. Pages: 142-143. Kenneth J. Ryan, Nafees Ahmed, J. Andrew Alspaugh, et al. : Sherris Medical Microbiology. 7th Edi6on. 2018. McGrow Hill Educa6on. Pages: 667-669. Any Questions???? Thank You