Medical Technology Assessment Program 1 PDF

MEDICAL TECHNOLOGY ASSESSMENT PROGRAM 1 ​ PROF MAIDY MEJORADA | A.Y. 2024-2025 | 4TH YEAR 1st Semester | PRELIMS LESSON 1 PART 2: ​ Virulence factors FAMILY ENTEROBACTERIACEAE ORGANISMS...

MEDICAL TECHNOLOGY ASSESSMENT PROGRAM 1 ​ PROF MAIDY MEJORADA | A.Y. 2024-2025 | 4TH YEAR 1st Semester | PRELIMS LESSON 1 PART 2: ​ Virulence factors FAMILY ENTEROBACTERIACEAE ORGANISMS ​ Pili - adhere to epithelial cells ​ Cytolysins - Opportunistic Members Primary Intestinal Pathogens inhibit immune Escherichia coli Salmonella effector cells Klebsiella Shigella ​ Aerobactin - chelates Enterobacter Yersinia calcium Serratia Citrobacter Enterotoxigenic E.coli (ETEC) ​ Epidemic (infant) Proteus diarrhea and traveler’s Morganella a.k.a Montezuma’s diarrhea Providencia Revenge/Turista ​ Profused/Watery Hafnia cholera-like diarrhea Edwardsiella Cedacea ​ Virulence factors Kluyvera ​ Pili ​ Heat-labile (LT) and New Member: Plesiomonas shigelloides heat-stable (ST) enterotoxins I.​ OPPORTUNISTIC MEMBERS ​ Plasmid + ​ Increase secretion of fluids and electrolytes Escherichia coli Enteroinvasive E. coli (EIEC) ​ Virulence factor ​ Colon Bacillus - NORMAL GIT FLORA (stool) ○​ Invades electrolytes ​ Primary marker of fecal contamination causing 00:06:08 – 00:12:16 - Kevin ​ #1 cause of UTI Shigella-like ​ SEROTYPES infection ​ Nephropathogenic or Uropathogenic E.coli ​ Causes bloody diarrhea (UTI) due to its ability to ​ Diarrheagenic or Enterovirulent E.coli invade the bowel (Diarrhea) mucosa ​ MUST KNOW: IMViC Reaction: + + - - ​ Site of action: Large intestine ○​ Which causes NOTES: TSI: A/A, Gas +, H2S - ; EMB: Greenish metallic disease in sheen underdeveloped countries ○​ The usual signs and symptoms are fever, cramping, and watery diarrhea which may progress to Dysentery or scanty or bloody stool ​ Dysentery and Bloody stools ​ It contains plasmid-mediated invasion ○​ Which could destroy the epithelial cells at the lining of the large intestine Uropathogenic E.coli ​ Most common cause of ○​ Invasion → UTI in humans destruction of (Acute/Chronic) epithelial cells at the colon/large intestine ​ Can also cause → ulcer formation uncomplicated cystitis ​ Sereny test (+) (hemolysin) & ○​ Which could cause complicated infected eyes like pylonephritis (pili) 1 MEDICAL TECHNOLOGY ASSESSMENT PROGRAM 1 ​ PROF MAIDY MEJORADA | A.Y. 2024-2025 | 4TH YEAR 1st Semester | PRELIMS Shigella “Sorbitol MacConkey” & MUG ​ Strains can be Test non-motile or non-lactose fermenter ​ Mug Test - test to differentiate the serotype of E. coli Enteropathogenic E. coli ​ Virulence factor (EPEC) ○​ Bundle-forming pilus for attachment to cells of the vowel movement ​ Infantile diarrhea (watery with mucus but no blood) ​ Non-toxigenic ​ Non-invasive ​ But could cause infantile diarrhea compared to EIEC Sorbitol MacConkey (SMac) Enterohemorrhagi ​ Also known as Verotoxic E. c E. coli (EHEC) coli (VTEC) ​ Site of infection: Large Intestine ​ It causes watery diarrhea followed by a Grossly blood diarrhea - “HEMORRHAGIC COLITIS WITH ABDOMINAL CRAMPS” ​ Mode of Transmission: ​ It is selective and differential Ingestion of undercooked media for the detection of hamburger, because the sorbitol- nonfermenting organism might reside in the Escherichia coli serotype feces of cattles & cow. 0157:H7 (associated with hemorrhagic colitis) ​ Disease: It will progress to Hemorrhagic colitis and ​ E. coli serotype 0157:H7- Hemolytic Uremic Syndrome standard lactose organism ​ HUS - Increase in ​ E. coli is lactose fermenters but blood & characterized not all can ferment sorbitol with Acute Renal Failure ​ SMac is the fermentable CHO of ​ Can cause bleeding MaConkey Agar (same color tendencies indicator and components but ❖​ If there is differs in fermentable CHO) bleeding, because for SMac, lactose is there will be change with sorbitol THROMBOC YTOPENIA or ​ All organism can ferment decreased sorbitol that would result in platelets PINK color onto culture media ​ Virulence factors ​ 0157:H7 E.coli - sole type of ​ Cytotoxin - phage E.coli serotype that would result mediated to non-fermenting sorbitol = ​ Serotype 0157:H7 NEGATIVE - COLORLESS strain ​ EHEC is NEGATIVE in SMac Enteroadherent E. ​ Diffusely adherent E. coli 2 MEDICAL TECHNOLOGY ASSESSMENT PROGRAM 1 ​ PROF MAIDY MEJORADA | A.Y. 2024-2025 | 4TH YEAR 1st Semester | PRELIMS coli (DAEC) Klebsiella spp. ​ Associated with UTI and diarrheal disease ​ Also known as “Friedlander’s Bacillus/Bacilli”. ​ Constitutes to another group of Diseases syndromes diarrhea genic of E. coli ​ Respiratory infection – particularly pneumonia ​ Cause diarrhea in healthy ​ Wound infection patients and children ​ UTI ​ Blood (septicemia) ​ Can cause watery mucoid ​ CSF (meningitis) diarrhea w/o RBCs or WBCs (no blood or pus cells) Other Characteristics Enteroaggregativ ​ This serotype could cause ​ Virulence factor e E. coli (EAEC) Acute & Persistent diarrhea in ○​ May be encapsulated and appear as children & adults mucoid colonies that tend to “string”. ​ Neufeld Quellung (+) ​ Can cause pediatric diarrhea on ​ String Test (+) which it could cause mucoid ​ Klebsiella pneumoniae is associated with ESBL diarrhea w/o RBCs and WBCs (Extended Spectrum Beta Lactamase) ○​ A strain on which confers resistance to ​ Site of Infection: Small beta-lactam drugs Intestine causing diarrhea ​ Klebsiella pneumoniae ○​ Causative agent of community acquired ​ Signs & Symptoms: pneumonia Dehydration, low grade fever & ○​ Appearance of currant jelly-like sputum vomiting ○​ Very mucoid ​ IMViC Reaction: - - + + ​ This serotype is plasmid ○​ Opposite of E. coli mediated aggregative adherence K. oxytoca ​ Indole (+) ​ Adhere to HEp2 in a ​ IMViC (+ - + +) aggregative stacked - ​ Same infection with brick pattern due to K. pneumoniae aggregative adherence ○​ Bacteremia ​ Cause of shortening of ○​ UTI microvilli ​ Main difference ​ Can cause of decrease with K. pneumoniae of fluid absorption & is Indole testing Increase biofilm release of cytotoxin, enterotoxins and K. ozaenae ​ Cause chronic hemorrhagic atrophic rhinitis tendencies characterized by a purulence sinus ​ Produces watery diarrhea infection K. rhinoscleromatis ​ Produce Other Diseases caused by Escherichia coli granulomatous disease of the nose ​ Nosocomial meningitis ​ Cause infection of ○​ Due to Ags or pathogens with capsules the oropharynx ○​ Usually acquired via vaginal sepsis due to prolonged delivery K. granulomatis ​ Cause granuloma ​ Nosocomial infections inguinale ○​ Pneumonia -​ Formerly (Donovanosis) ○​ Wound infection Calymmatobacteri ○​ An STD that ○​ Bacteremia um ganulomatis causes ○​ Endotoxic shock chronic ​ Sepsis genital ○​ E. coli - most common cause gram (-) ulcerative sepsis 3 MEDICAL TECHNOLOGY ASSESSMENT PROGRAM 1 ​ PROF MAIDY MEJORADA | A.Y. 2024-2025 | 4TH YEAR 1st Semester | PRELIMS disease K. pneumoniae subs. oxytoca + - - ​ Diagnosis is through staining E. aerogenes + + - ○​ Wright or Giemsa stain E. cloacae - + + ○​ Look for Donovan's LDC – lysine decarboxylase; ODC – ornithine bodies. decarboxylase; ADH – arginine dihydrolase Presence of 1-25 bacteria is significant Serratia spp. ​ Virulence Factors Enterobacter ○​ Nosocomial and opportunistic pathogens causing: ​ Lactose fermenting organism ​ Bacteremia ​ NORMAL FLORA but may cause opportunistic ​ Septicemia infections ​ UTI ​ Most Predominant Isolate: E. cloacae ​ Respiratory Tract (pneumonia) ​ Changes in the names of organisms ​ Wound infection ○​ E. sakazakii is now Cronobacter sakazakii ○​ E. aerogenes is now Klebsiella aerogenes ​ Known to produce yellow pigment that intensifies at Other Informations room temperature. ​ ONPG (+) ​ Can cause necrotizing colitis – due to powdered ​ Most common isolate for genus Serratia infant milk formula ○​ S. marcescens ​ Produces a red pigment (also Important IMViC Reactions for Lactose Fermenters known as PRODIGIOSIN) in MacConkey INDOL MR VP CITRAT ​ Produces 3 enzymes E E ​ (+) for Gelatinase ​ (+) for Lipase E. coli + + - - ​ (+) DNase K. pneumoniae subs. - - + + pneumoniae Citrobacter spp. K. pneumoniae subs. + + - + ​ Formerly known as: Bethesda-Ballerup group oxytoca ○​ ONPG (+) ○​ Late lactose fermenter Enterobacter - - + + ​ Produce A/A results after 24 hours ​ The majority of the isolates are from the urinary tract and neonatal infections MR – Methyl Red VP – Voges-Proskauer ​ Formerly may be nonpathogenic (more frequent), opportunist or true intestinal pathogen K. pneumoniae subs. Pneumoniae has the same IMViC reaction with Enterobacter spp. Differentiation of Serratia and Citrobacter Species ⭐️BOARD QUESTION ⭐️ S. C. freundii C. koseri marcescens (diversus) ​ Usually asked question in the board exam are the IMViC of E. coli and K. pneumoniae TSI A/A or K/A A/A or K/A K/A Gas -/+ + + Important Decarboxylase Reaction for Lactose Fermenters H2S - + - LDC ODC ADH Indole - - + K. pneumoniae subs. + - - MR + + + pneumoniae 4 MEDICAL TECHNOLOGY ASSESSMENT PROGRAM 1 ​ PROF MAIDY MEJORADA | A.Y. 2024-2025 | 4TH YEAR 1st Semester | PRELIMS ○​ There are the same biochemical VP + - - characteristics in the tribe, but no swarming ​ Normal Intestinal Flora Citrate + + + ​ Species: ○​ P. stuartii LDC + - - ○​ P. rettgeri Morganella spp. KCN + + - ​ Can cause septicemia (Growth) ​ Species: ○​ M. morganii Tribe Proteeae Differentiation of Tribe Protreeae ​ Proteus, Morganella, and Providencia ​ Virulence factor Reaction P. P. Prov. Prov. M. ○​ Opportunistic causing bacteremia, mirabilis vulgaris stuartii retgerri morga septicemia, urinary tract, and wound nii infection Indole - + + + + ​ Laboratory Diagnosis ○​ Rapid Urease Producing organisms MR/VP +/- +/- +/- +/- +/- ​ 14days ​ Widal test YERSINIA SPP. ○​ Obsolete test ○​ Detecting OLH antibodies ➔​ Yersinia pestis (Bioterrorism agent) ​ Typhidot ➔​ Exhibit a “Stalactite Pattern” in broth culture ○​ Detecting IgM & IgG ◆​ Disease: Plague, Bubonic Plague & Pneumonic Plague ◆​ MOT: Zoonotic (Flee Bites) ◆​ Laboratory Diagnosis: Safety Pin appearance & Cauliflower appearance at 48hrs in Sheep Blood Agar ➔​ Yersinia pestis is nonmotile at any temperature. 6 MEDICAL TECHNOLOGY ASSESSMENT PROGRAM 1 ​ PROF MAIDY MEJORADA | A.Y. 2024-2025 | 4TH YEAR 1st Semester | PRELIMS ➔​ CIN medium for Yersinia spp. Yersinia enterocolitica ​ Late lactose fermenter (LLF) ​ It could tolerate cold enrichment ○​ Disease: ​ Enterocolitis, arthritis and Erythema nodosum ○​ Laboratory Diagnosis: ​ Bipolar staining & safety pin appearance ​ It has bull’s eye colonies in CIN in 48h ​ Preferential growth for using enterocolitica is at 25°C because it’s motile at 25°C but nonmotile at 37°C Yersinia pseudotuberculosis ​ Motile at 25°C and nonmotile at 37°C ○​ Disease: ​ Association with pseudotubercles & this could cause mesenteric lymphadenitis ○​ Laboratory diagnosis: ​ Same with other organisms under genus yersinia it has safety pin appearance due to bipolar staining. CEFSULODIN-IRGASAN-NOVOBIOCIN (CIN) Cefsulodin Inhibits both gram-positive & gram-negative organisms Novobiocin Inhibits gram-positive bacteria Crystal Violet Inhibits gram-negative bacteria Edwardsiella tarda ​ Cause wound infections and bacteremia Hafnia alvei ​ previously known as Enterbobacter alvei ​ Considered as LLF with delayed citrate activity Plesiomonas shigelloides ​ Oxidase test (+) ​ Can cause secretory diarrhea in AIDS px with inflammatory bowel disease ​ New member of the family enterobacteriaceace which is a former vibrio organism Cedecea spp. ​ Most have been recovered from sputum, blood, and wounds. Kluyvera spp. ​ They have been found in respiratory, urine, and blood cultures ​ Most strains as nonpigmented, but occasional isolates may produce a blue to purple pigment ​ All species resembles E. coli colonies growing on MAC agar 7