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The Family: Pseudomonaceae

Genus Pseudomonas P.aeuroginosa P. fluorescens

Genus Pseudomonas

Common inhabitants of soil ,water, occur on surfaces of plants and animals. Pseudomonas aeruginosa : Is the major pathogen of this group Is the epitome of opportunistic pathogens Produce infections in patients with abnormal defenses, so it is an important nosocomial pathogen.

Morphology

Gr (-) bacilli , motile with single or more polar flagellum Non spore formers.

Cultural characteristics

Is an obligate aerobe that can grow on many types of culture media, sometimes with sweet or grape like –odor.Some strains produce hemolysis on blood agar.Selective media: contain cetrimide, acetamide and nitrofurantoinForm smooth, round colonies with fluorescent greenish color.Some strains produce water soluble pigments , either red color (pyorubrin ) or black pigment (pyomelanin), or produce the non fluorescent( pyocyanine) pigment .Strains isolated from (R.T. or U.T. ) produce mucoid colonies (alginate slim ).Is an oxidase test (+) Does not ferment any carbohydrates , but ,many strains can oxidize glucose .Able to grow at 42 cUrea hydrolysis +ve Lysin and arginine decarboxylaters

Antigenic structure and toxins

Pili (fimbria) :extend from the cell surface and promote attachment to epithelial cells (of the R.T. , U. T. and cornea ). LPS : responsible for many of the endotoxic properties of the m.o. Many strains produce extracellular enzymes including , elastase , protease , two hemolysin, heat labile phospholipase C . These cytotoxins and hemolysins contribute to invasion through their cytotoxic effect on eukaryotic cells . Many strains produce exotoxin A , has the same mechanism of action as that of diphtheria toxin . It blocks protein synthesis in the host cells causing a necrotizing activity at the site of bacterial colonization process. The blue pigment (pyocyanin ) impairs the normal function of nasal cilia and disrupt the respiratory epithelia . Enterotoxin : interupts normal GIT producing diarrhea .

Pathogenesis

Disease process starts with some alteration of normal host defenses e.g. : when skin or m.m. is disrupted by direct tissue damage (burn) , or during use of IV or urinary catheter, during neutropenia especially after chemotherapy of malignant disease Most pseudomonas infections are both invasive and toxinogenic . Pseudomonas infections composed of three stages : 1. bacterial attachment and colonization 2. local tissue invasion 3. disseminated systemic disease , however the disease process may stop at any stage . These processes are promoted by the pili, enzymes , toxins , LPS.


Diseases caused by Pseudomonas aeruginosa
Skin and soft tissue infections: wound and burn infections giving rise to blue-green pus . Meningitis and brain abscess :m.o. invades the CNS from a contiguous structure such as inner ear , or is inoculated directly by means of head trauma ,surgery , lumber puncture. U.T.I. : usually hospital acquired after catheterization or surgery or instrumentation , m.o can invade the blood stream from the urinary tract and is the source of about 40% of bacteremia . Respiratory infections :occur in patients with abnormal lower R.T. (cystic fibrosis ) .Necrotinzg pneumonia by contaminted respirators

Cont,

Eye infections :one of the most common causes of keratitis , neonatal ophthalmia , it can colonize the corneal epithelia by mean of fimbrial attachment (occur after surgery or injury )

Cont,

Cont,

Diseases caused by Pseudomonas aeruginosa

Ear infections : cause otitis externa including (swimmers ear) , the m.o. often inhabit the external auditory canal and can cause infection in association with injury , maceration or simply wet and humid conditions. Bacteremia : predisposing conditions include hematologic malignancies , AIDS patients , neutropenia , D.M. , severe burns . Most pseudomonas bacteremias are acquired in hospitals

Treatment

P.aeruginosa is notorious for its resistance to antibiotics . It should not be treated with single drug therapy. Is naturally resistant to certain antibiotics due to permeability barrier afforded by its outer LPS . Maintains antibiotic resistant plasmids. Is sensitive to ticarcillin , piperacillin & carbencillin used in combination with aminoglycosides ,tobramycin , gentamicin Other drugs are imipenem , meropenem. Ciprofloxacillin . New cephalosporins such as ceftazidime, cephaperazone Susceptibility pattern varies geographically and sensitivity test should be done before selection of antimicrobial drugs .





رفعت المحاضرة من قبل: Omar The-Czar
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