Pathogenic Organism

Pathogenic Organism Chart
Genus/Organism Description Habitat/Sources of Isolation Pathogenicity Symptoms *Treatment

Aeromonas (PP): Aeromonas is a Aeromonads are ubiquitous in fresh Definitive experimental Aeromonas gastroenteritis may Most Aeromonas
*Aeromonas gram-negative rod water environments. The number evidence for the affect both children and adults species are generally
hydrophilia/caviae belonging to the present is dependant on the extent of causative role of with the highest seasonal susceptible to
*Aeromonas veronii Vibrionaceae sewage pollution and the ambient Aeromonas in incidence occurring in the cephalosporins,
biovar sobria family. temperature. gastrointestinal summer months. aminoglycosides,
*Aeromonas biovar Recent studies have directly disorders is still carbapenems,
veronii There are at least attributed Aeromonas as the cause of lacking. Symptoms tend to be generally tetracyclines,
*Aeromonas species four species of food-borne infections. The following mild, self-limiting diseases with trimethoprim-
Aeromonas with A. foods may harbor the organism: raw Although human watery diarrhea.6 sulfamethoxazole and
hydrophilia being meat, freshwater fish, shellfish and volunteer studies are quinolones.9
the most common other seafood. Raw milk can also be inconclusive, Bloody stools have been
isolated species in a source of infection.3 epidemiological reported. Aeromonas infections Susceptibility must
the U.S.1 2 evidence has shown tend to be more acute in children guide testing.
that the presence of and more chronic in adults.7 8
these organisms in
stools is significantly
more often associated
with diarrhea than with
the carrier state.4 5
© 2003 Great Smokies Diagnostic Laboratory


Bacillus (PP): Bacillus species are Sources of the diarrheal type of B. Although part of the B. cereus is the etiological agent B. cereus is almost
*Bacillus cereus spore forming, cereus food poisoning include: normal flora, B.cereus of two distinct types of food always susceptible to
gram-positive rods meats, pasta, vegetable dishes, has been established as poisoning: clindamycin,
belonging to the desserts, cakes, sauces and milk.13 an opportunistic 1) The diarrheal type, erythromycin and
Bacillaceae pathogen.16 which is caused by a vancomycin.24
family.10 11 The emetic type of infection is heat-labile enterotoxic
predominately associated with The gram-positive complex. Symptoms
There are currently oriental rice dishes. Pasteurized spore forming rods of include abdominal pain,
50 valid species cream, milk pudding and pasta have B.cereus elaborate and diarrhea 8-12 hours
within the genus.12 occasionally been implicated.14 enterotoxins.17 after ingestion of the
Both types of food organism.20 21
The incidence of B. cereus infection poisoning result from 2) The emetic type, caused
is increased during the summer spores that have by a heat-stable
months.15 survived cooking, then enterotoxin. Nausea and
germinated, producing vomiting usually occur
vegetative cells that 1-5 hours after
have multiplied.18 ingestion.22 23
NB, it is estimated that only

half the isolated strains of B.
cereus are enterotoxin
19
positive.
*Bacillus species Meat dishes are a common source of As yet, no toxins or B. licheniformis and B. subtilis
infection in other species of Bacillus other virulence factors are associated with food-borne
such as B. subtilis and B. have been identified in diarrheal illness.27
licheniformis.25 association with the
symptoms that
accompany non-B.
cereus species.26


Campylobacter jejuni Campylobacter are Poultry is a key source of infection, Recognized as the The incubation period can be 2 Erythromycin is the
(P) gram-negative, in particular chicken. Red meat and principle cause of to 10 days, though is usually 2 to drug of choice for
non-spore forming shellfish can also harbor the diarrhea in humans. 5 days.34 treating C. jejuni
rods belonging to organism.30 C. jejuni and C. coli are infections.
the the most common Symptoms can include fever, Ciprofloxacin may be
Campylobacterace Other sources include unpasteurized species associated with abdominal cramping, diarrhea an alternative drug.36
ae family.28 milk, and water contaminated by diarrheal illness.32 (often bloody) abdominal pain
wild birds.31 and fever. Relapses may occur
In total there are 18 The infective dose as in 5%-10% of untreated cases.35
species and yet has not been clearly
subspecies within defined, but it is
the genus.29 thought that as little as
1000 organisms are
capable of causing
infection.33


Candida (PP): The genus Candida Most sources of Candida infection A normal inhabitant of The most common symptom Currently, standard
*Candida albicans is comprised of are thought to be of endogenous the GI tract. May attributable to non-invasive yeast texts provide no
*Candida famata approximately 200 origin.39 become an overgrowth is diarrhea.50 specific antifungal
*Candida glabrata different species.37 opportunistic pathogen guidelines for GI
While yeast are ubiquitous in the after disruption of the Symptoms of chronic candidiasis overgrowth of
*Candida C. albicans is the environment and are found on fruits, mucosal barrier, affect four main areas of the Candida.
guilliermondii most commonly vegetables and other plant materials, imbalance of the body: Oral azoles have been
isolated strain from contamination from external sources normal intestinal flora Intestinal system – symptoms recommended for
*Candida krusei the GI tract.38 is linked to patients and health care and/or impaired include: diarrhea, constipation, extra intestinal
workers.40 41 immunity.42 43 44 45 abdominal discomfort, infections.
*Candida lambica distention, flatulence and rectal Susceptibility testing
Risk factors for itching. is advised due to
*Candida lusitaniae colonization include: Genital Urinary system – increasing drug
Antibiotics, symptoms include: menstrual resistance.53 54
*Candida parapsilosis corticosteroids, complaints, vaginitis, cystitis
antacids, H2 blockers, and urethritis.
*Candida oral contraceptives, Nervous system – symptoms
paratropicalis irradiation, GI surgery, include: severe depression,
Diabetes mellitus, extreme irritability, inability to
*Candida burns, T cell concentrate, memory lapses and
pseudotropicalis dysfunction, chronic headaches.
stress and chronic renal Immune system – symptoms
*Candida rugosa disease.46 47 48 49 include urticaria, hayfever,
asthma, and external otitis.
*Candida species Sensitivities to tobacco,
perfumes, diesel fumes and other
*Candida stellatoidea chemicals.51 52
*Candida tropicalis
*Candida zeylanoides


Citrobacter (PP): Citrobacter is a Common in the environment and Citrobacter is Citrobacter has occasionally Currently, standard
gram-negative rod may be spread by person-to person considered an been implicated in diarrheal texts provide no
belonging to the contact. Several outbreaks have opportunistic pathogen disease, particularly C. freundii specific antimicrobial
*Citrobacter Enterobacteriaceae occurred in babies in hospital units.57 and therefore can be and C. diversus and C. koseri.61 guidelines for GI
amalonaticus family.55 58
found in the gut as part overgrowth of
*Citrobacter braakii Citrobacter Isolated from water, fish, animals of the normal flora.60 Citrobacter.62 63
*Citrobacter diversus contains 9 named and food.59
*Citrobacter freundii species and two Carbapenems and
unnamed fluroquinolones are
*Citrobacter
freundii/youngae genomospecies.56 the recommended
antibiotics for extra-
*Citrobacter freundii
intestinal sites.64 65
complex
*Citrobacter koseri
*Citrobacter species
Clostridium difficile The genus The organism has many natural C. difficile is the major Mild cases of C. difficile disease Severe C. difficile
(PP) Clostridium are habitats including hay, soil, cows, cause of antibiotic- are characterized by frequent, intestinal disease is
anaerobic gram- horses and dogs.67 associated diarrhea and foul-smelling, watery stools. usually treated with
positive, spore- Almost 50% of neonates carry this pseudomembranous More severe symptoms, oral vancomycin or
forming bacteria.66 organism asymptomatically as part of colitis and the most indicative of pseudomembranous metronidazole.
their gastrointestinal flora during the common cause of colitis, include diarrhea that However,
first year of life. This rate decreases hospital-acquired contains blood and mucous, and antimicrobial therapy
sequentially to about 3% in adults diarrhea.70 abdominal cramps.73 often results in
and less in children over two years of relapse of the
age.68 69 Isolation of C. difficile disease.74
without a positive toxin
test has little clinical In addition, there is
value. It is important to concern that oral
test for both toxins A vancomycin can lead
and B in the stool. to the emergence of
Toxin A is an vancomycin-resistant
enterotoxin and toxin B Enterococci.75
is a cytotoxin that
inhibits bowel motility.
It is thought that both
toxins are important in
the pathogenesis.71 72


Cryptococcus (PP): Cryptococcus is a Found in the excreta of pigeons and Can be an opportunistic Diarrhea has been associated Currently, standard
*Cryptococcus albidus yeast-like fungus, other birds in most parts of the world. pathogen, with Cryptococcal infection.81 texts provide no
*Cryptococcus which closely The yeast is associated with aged predominately in the specific antimicrobial
humicolus resembles the bird droppings that have accumulated immunocompromised Usually infection occurs in the guidelines for GI
*Cryptococcus genus Candida.76 over a long period of time on host.79 tissue of the central nervous overgrowth of
laurentii window ledges, vacant buildings and system but occasionally can Cryptococcus.83 84
*Cryptococcus The genus contains other roosting sites.78 Cryptococcus is produce lesions in the skin,
luteolus a number of considered one of the bones, lungs, or other internal Fluconazole is
*Cryptococcus species, of which defining diseases of organs.82 considered the
neoformans only C. neoformans AIDS. primary antimicrobial
*Cryptococcus species is considered to be Patients with agent in
*Cryptococcus terreus a human Cryptococcus and extraintestinal sites.85
*Cryptococcus pathogen.77 serologic evidence of
uniguttulatus HIV are considered to
have AIDS.80
Edwardsiella tarda(P) The genus Isolated from cold-blooded animals E. tarda is considered Diarrheal disease is associated If antibiotic treatment
Edwardsiella is a such as fish and reptiles and their an opportunistic with infection, with a clinical is required,
gram-negative rod environment.88 pathogen, occasionally picture similar to Salmonella ampicillin,
that belongs to the causing acute enteritis.92 trimethoprim-
Enterobacteriaceae Infection is more common in tropical gastroenteritis.90 91 sulfamethoxazole and
family.86 and subtropical environments and Isolation of the E. tarda is more ciprofloxacin have all
developing countries.89 common in young children and been found to be
To date there are the elderly.93 effective agents.94
three species,
though only E.
tarda is associated
with human
disease.87


E.coli Shiga-like toxin Shigatoxin-producing 0157 STEC colonize dairy and beef cattle, E. coli 0157:H7 and The STEC strains cause a spectrum Antimicrobial therapy
E. coli strains are which is why ground beef is the most 0157:non-motile (0157 of illness that can present as mild for 0157 STEC has
referred to as STEC. common infection vehicle. STEC) produce one or non-bloody diarrhea, severe bloody NOT been demonstrated
This includes the However, raw milk, sausage, roast beef, more Shiga toxins and, are diarrhea (hemorrhagic colitis), and to be effective or safe,
0157 and many other unchlorinated water, apple cider, and raw the most commonly hemolytic uremic syndrome except for cases of
STEC serogroups.95 vegetables have also been implicated.97 identified diarrheagenic (HUS).100 cystitis and
E.coli isolates in North pyelonephritis.102
In total, at least 100 America and Europe.98 About 6% of 0157 STEC patients
serotypes have been Non-toxin-producing develop HUS.101 Antimicrobial therapy
isolated from strains are normal in the for intestinal disease
persons with human intestine. 0157 may enhance toxin
diarrhea.96 STEC spreads easily from release and predispose
person to person because for HUS.103
the infectious dose is low.99
Enterobacter cloacae Gram-negative rod Widely distributed in the environment. Usually considered a Has been associated with diarrhea in Currently, standard texts
(PP) that is part of the Water, soil, sewage and cornstalks have all commensal organism; children.110 111 provide no specific
Enterobacteriaceae been identified as sources of however, strains of E. antimicrobial guidelines
family.104 contamination.107 108 cloacae have been shown for GI overgrowth of
to produce a heat-stable Enterobacter.112 113
There are 14 species toxin similar to that
in the genus, though produced by E.coli.109 Carbapenems are
only E. cloacae has recommended for extra-
been associated with intestinal sites.114
GI infection.105 106
Geotrichum (PP): Geotrichum are yeast This organism can be found in soil, dairy Usually only considered an Symptoms of Geotrichum infection Currently, standard texts
*Geotrichum candidum belonging to the products and in human skin and opportunistic pathogen in have been associated with diarrhea provide no specific
*Geotrichum capitum Endomyceteaceae mucosae.116 immune-compromised and enteritis.121 122 antifungal guidelines for
family. hosts.117 118 GI overgrowth of
There are several Symptoms of Geotrichosis may Geotrichum. Oral azoles
species within the Geotrichum candidum is resemble those of candidiasis.123 and have been
genus, of which G. the etiological agent of recommended for extra
candidum is the most Geotrichosis.119 intestinal infections.
common.115 Susceptibility testing is
Geotrichum may also play advised owing to
a role in IBS.120 increasing drug
resistance.124 125
*Geotrichum species

Hafnia alvei (PP) Hafnia is a gram- Commonly found in warm-blooded This organism is a Diarrheal illness has been Hafnia strains are
negative rod animals, particularly birds. Other natural inhabitant of the associated with outbreaks and usually susceptible to
considered part of environmental sources include GI tract in humans. virulence factors similar to piperacillin,
the contaminated water, sewage, food, Hafnia strains are toxigenic E.coli have been imipenum,
Enterobacteriaceae and dairy products.127 opportunistic described.129 quinolones and the
family. pathogens; community newer
There is only one and hospital outbreaks cephalosporins.130
species of Hafnia– have been associated
H. alvei–which was with GI infection.128
previously a
member of the
Enterobacter
genus.126
Helicobacter pylori The genus Reservoirs of infection include the H. pylori causes chronic Those infected with H. pylori Cure rates require
(P) Helicobacter are intestinal tract of mammals and birds. gastritis and may develop acute gastritis with multi-drug regimens
gram-negative, Mode of transmission is usually via predisposes to gastric symptoms of abdominal pain, along with antacid
non-spore forming the fecal-oral or oral-to-oral route.133 and duodenal ulcers. nausea and vomiting, usually medications.137
rods. Increased risk of gastric within two weeks of infection.
There are currently carcinoma is associated Many patients have recurrent The most successful
19 species within with infection.134 abdominal symptoms (non-ulcer treatment includes a
the genus.131 dyspepsia) without ulcer combination of
It is estimated that 50% disease.136 metronidazole,
Seroprevalence of of the world’s omeprazole and
H. pylori varies population is infected clarithromycin.138
from 20% in young with H. pylori.135
adults in developed
countries to
sometimes more
than 90% in
developing
countries.132


Klebsiella (PP): Klebsiella is part of Isolated from foods and Part of the normal GI K. pneumoniae and K. oxytoca Currently, standard
*Klebsiella the environmental sources.141 flora in small numbers, have been associated with texts provide no
ornithinolytica Enterobacteriaceae but can be an diarrhea in humans.152 153 154 155 specific antimicrobial
156 157
*Klebsiella oxytoca family and as such Klebsiella appears to thrive in opportunistic pathogen. guidelines for GI
*Klebsiella ozaenae is a gram-negative individuals on a high starch diet. Klebsiella is capable of overgrowth of
*Klebsiella rod.139 Avoiding carbohydrates such as rice, translocating from the Cytotoxin-producing strains are Klebsiella.165 166
pneumoniae potatoes, flour products and sugary gut when in high associated with acute
*Klebsiella There are 7 species foods reduces the amount of numbers.143 144 hemorrhagic enterocolitis.158 159 Third generation
rhinoscleromatis of Klebsiella Klebsiella in the gut.142 160 161 162
cephalosporins and
*Klebsiella species within the genus, Certain strains of K. fluroquinolones are
though only 2 have oxytoca have Increased colonization of the recommended
been associated demonstrated cytotoxin Klebsiella in the stool has been antimicrobial agents
with GI production.145 146 147 148 found in HLA-B27 + AS for extra-intestinal
infection.140 149
patients.163 164 sites.167
Of the 77 Klebsiella
capsular
polysaccharides, only 3
are associated with
ankylosing spondylitis:
K26, K36 and K50. 150
151


Listeria The genus Listeria Dairy products are sources of GI symptoms have been Symptoms of diarrhea have been Listeria is usually
monocytogenes (PP) are gram-positive Listeria infection. The organism has associated with noted with Listeria infection.176 susceptible to
cocciod- to rod- been found in raw milk, pasteurized infection, though are penicillin, ampicillin,
shaped bacteria of milk, cream, butter, cheese and ice not usually related to gentamycin,
which there are 7 cream.170 the ingestion of erythromycin, and
species in total.168 The use of manure as fertilizers on contaminated food.173 tetracycline.177
salad and vegetable crops have been
The only species associated with Listeria infection.171 A transient intestinal
associated with Fish and seafood may also be a carrier state exists in
infection in reservoir of infection.172 2%-20% of humans.174
humans is L.
monocytogenes.169 Development of an
invasive infection
depends on several
factors, namely: host
susceptibility, gastric
acidity and the
virulence of the
organism.175
Moellerella Meollerella is a Contaminated water supplies are the The exact role of Diarrhea and gastroenteritis have Currently, standard
wisconsensis (PP) gram-negative rod main reservoir of infection.180 Moellerella in causing been associated with M. texts provide no
that is part of the diarrhea has not yet wisconsensis.182 183 specific antimicrobial
Enterobacteriaceae been fully elucidated.181 guidelines for GI
family.178 overgrowth of
Currently, there is Moellerella.184 185
only one species in
the genus.179 MIC studies have
demonstrated
susceptibility to
cephalothin,
gentamicin and
naladixic acid.186


Morganella morganii Morganella is M. morganii originates from the gill The role of Morganella Diarrhea has been associated Currently, standard
(PP) gram-negative rod and skin of fish. It is possible that it as an etiological agent with infection of this texts provide no
belonging to the may cross-contaminate during in diarrheal disease is organism.193 194 specific antimicrobial
Enterobacteriaceae handling of fish in processing plants controversial. Although guidelines for GI
family.187 and restaurants.189 Morganella constitutes overgrowth of
part of the normal flora, Morganella.195 196
Currently, there are in certain hosts it may
3 species within the be a potential Carbapenems, 3rd and
genus.188 pathogen.190 191 4th generation
cephalosporins and
Recently it was shown fluroquinolones are
that the majority of the agents
clinical isolates of recommended for
Morganella belonged to extra-intestinal
the subsp Morganii.192 infections.197
Plesiomonas Plesiomonas is a Usually found in fresh water or P. shigelloides is not a Symptoms range from short- P. shigelliodes is
shigelloides (PP) gram-negative rod estuarine water. Occurs in fish, natural inhabitant of the lived episodes of watery stools susceptible to most
belonging to the shellfish, oysters, toads, snakes, GI tract.204 to several days of dysentery-like major classes of
Vibrionaceae monkeys, dogs, cats, goats, pigs, diarrhea. Has not been reported antibiotics, including
family, though it poultry, and cattle.200 Although feeding to affect specific age groups trimethoprim,
does contain the studies with humans more often than others.206 207 cephalosporins, and
Enterobacteriaceae There is a low incidence of resulted in the excretion quinolones.211
antigen. Plesiomonas shigelliodes in the US of the organism (but not Accompanying symptoms vary
P. shigelloides is and Europe.201 diarrhea) from about and may include abdominal pain,
the only species in one third of the nausea, vomiting, chills,
the genus.198 199 In Asia, however, the organism volunteers, several headaches and dehydration..208
contributes to a significant proportion epidemiological studies
of traveler’s diarrhea.202 203 suggest that Infections with P. shigelloides
Plesiomonas is a are usually self-limiting, lasting
possible agent in GI up to 7 days and occasionally
disease. It has been longer.209 210
isolated from human
stool specimens in the
absence of symptoms
and may be difficult to
attribute as the cause of
diarrhea in some
cases.205


Proteus (PP): Proteus is a gram- Food has been implicated as a Part of the normal flora Occasionally implicated in Currently, standard
*Proteus mirabilis negative rod vehicle of infection.214 of the GI tract, though diarrheal disorders.217 218 texts provide no
*Proteus penneri belonging to the has been shown to be specific antimicrobial
*Proteus vulgaris Enterobacteriaceae an independent Recently, it has been suggested guidelines for GI
family.212 causative agent of that P. mirabilis may be an overgrowth of
intestinal disorders.215 etiological agent in rheumatoid Proteus.220 221
10 species in total arthritis.
are attributed to the May also play a role as The mechanism may be related Ampicillin is
genus of which P. an opportunistic to the molecular cross reactivity recommended for
mirabilis is organism in enteric between P. mirabilis and the extra-intestinal
considered the infection due to other HLA antigens, specifically infections of P.
most important.213 pathogens.216 HLA-DR4.219 mirabilis, followed
by trimethoprim-
sulfamethoxazole.222
Provedencia Provedencia is a GI tract infection with P. Provedencia is not This organism has been Currently, standard
alcalifaciens (PP) member of the alcalifaciens has been associated normally present in a implicated as a cause of texts provide no
Enterobacteriaceae with overseas travel.225 healthy GI tract.226 diarrhea.228 229 specific antimicrobial
family of which guidelines for GI
there are Its pathogenic role may P. alcalifaciens is thought to overgrowth of
5species.223 224 lie in the ability of the induce invasive diarrhea in Providencia.231 232
organism to take patients by invading cells in the
advantage of conditions intestine, thus producing 3rd generation
created by other inflammatory changes in the cephalosporins and
infectious microbes.227 ileum.230 fluroquinolones are
recommended for
extra-intestinal
sites.233 234

Pseudomonas (PP): Pseudomonas Found in water and soil as well as Pseudomonas is Associated with diarrheal Ciprofloxacin is
*Pseudomonas species are aerobic, fruits and vegetables. considered an infection, particularly in the recommended for the
aeruginosa non-spore forming Bottled water can be a common opportunistic immunocompromised host.240 241 treatment of
*Pseudomonas species gram-negative source of infection. pathogen.238 Pseudomonas-
rods.235 Because the organism is able to Pseudomonas can also be an induced antibiotic-
survive aqueous environments, it is Animal studies have etiological agent of antibiotic- associated colitis.243
There are 10 an important nosocomial pathogen. isolated an enterotoxin associated diarrhea.242
species in the Pseudomonas can also be found on a thought to be Pseudomonas is
genus, though P. number of surfaces and in aqueous responsible for causing usually susceptible to
aeruginosa is solutions.237 diarrhea.239 antipseudomonal
considered the penicillins,
most important aminoglycosides,
pathogen.236 carbapenems, 3rd
generation
cephalosporins and
gentamycin.244 245
Saccharomyces Saccharomyces are S. cerevisiae is a commonly used S. cerevisiae commonly Studies have shown that patients Currently standard
cerevisiae (PP) yeast belonging to industrial microorganism and is colonizes mucosal with S. cerevisiae overgrowth texts provide no
the ubiquitous in nature, being present on surfaces, and is rarely usually have an underlying specific antifungal
Sacccharomycetac fruits and vegetables. considered an disease.254 guidelines for GI
eae family. Also known as opportunistic overgrowth of
Currently there are Baker's Yeast or Brewer's Yeast, this pathogen.250 251 252 Disseminated infections are Saccharomyces.
18 species within organism has been used for centuries thought to arise from the
the genus of which as leavening for bread and as a Severe gastrointestinal tract.255
S. cerevisiae is the fermenter of alcoholic beverages.248 immunosuppression,
most common.246 249
prolonged
247
hospitalization, and
antibiotic therapy are
all associated
withSaccharomyces
infection..253
Overgrowth may be
associated with dietary
ingestion of S.
cerevisiae and/or S.
boulardii as part of a
"health food" regimen.


Salmonella (P): Salmonella are Animals and birds utilized for meat Salmonella are Gastroenteritis and diarrhea are Antimicrobial
*Salmonella Group C members of the are subject to contamination with considered frank caused by more than 2000 therapy is not
and D Enterobacteriaceae Salmonella. Eggs, cereals and cereal pathogens in humans. serotypes producing infections recommended for
*Salmonella arizonae family and as such products are other sources of These organisms are limited to the mucosa and uncomplicated
*Salmonella group A are gram-negative contamination.257 NOT part of the normal submucosa of the GI tract. Salmonella
*Salmonella group B rods.256 bowel flora. S. typhimurium and S. enteritidis gastroenteritis.262
*Salmonella group C The incidence of infection increases are the serotypes most common
*Salmonella group D over the summer, and is Salmonella species are in the US. Antimicrobial
*Salmonella group E predominantly associated with acute acid-sensitive, invasive, Bacteremia and extraintestinal therapy is warranted
*Salmonella group E diarrhea in infants.258 and produce infections occur by spread from in cases of
+G enterotoxins in the GI the GI tract, and any serotype is bacteremia.
*Salmonella paratyphi tract. Several thousand capable of causing bacteremia.260 Enteric fever
261
A cells may be needed to (typhoid fever) is
cause infection.259 characterized by
*Salmonella paratyphi
prolonged fever and
B
multisystem
*Salmonella paratyphi
involvement. This is
C
a life-threatening
*Salmonella species
infection caused by S.
*Salmonella typhi typhi or S. paratyphi.
Antimicrobial
therapy is needed in
cases of typhoid
fever.263

Serratia marcesens Serratia is a gram- Serratia is more often associated A natural inhabitant of In neonates the gastrointestinal Currently, standard
(PP) negative rod with nosocomial infection, and the GI tract, though on system is an important source of texts provide no
belonging to the seldom occurs in the community. occasion can become an the organism.267 specific antimicrobial
Enterobacteriaceae The most common route of opportunistic guidelines for GI
family.264 transmission is hand-to-hand spread pathogen.266 overgrowth of
via nurses, physicians and other Serratia.268 269
healthcare workers.265
Third generation
cephalosporins,
carbapenems, and
fluroquinolones are
the recommended
antibiotics for extra-
intestinal
infections.270


Shigatoxin-producing
E.coli (STEC )- See
E.coli Shiga-like
toxin.
Shigella (P): Shigella are Spread from person to –person by the Shigella is only found Symptoms can range from mild Shigella infections
*Shigella boydii members of the fecal-oral route, especially in in humans at times of to explosive diarrhea. It is are often treated with
*Shigella dysenteriae Enterobacteriaceae overcrowded areas and areas with infections and is NOT somewhat acid-resistant, invades antibiotics, and
*Shigella flexneri family. There are 4 poor sanitary conditions. Ingestion is part of the normal epithelial cells, and produces antimicrobial
*Shigella sonnei serogroups that also a primary source of infection.272 bowel flora. toxins. Less than 100 cells are susceptibility testing
*Shigella species have historically required to initiate infection.275 is recommend owing
276
been treated as A predominant organism responsible All species are to widespread
species: for acute diarrheal disease in infants considered frank resistance.278
-S. dysenteriae and children.273 pathogens in humans.274 S. dysenteriae is rare in the US
(Serogroup A) and causes classic dysentery, Resistant strains are
-S. flexneri producing the Shiga toxin. usually susceptible to
(Serogroup B) S. sonnei is most common in the the
-S. boydii US, and usually produces only a fluroquinolones.279
(Serogroup C) watery diarrhea.277
-S. sonnei
(Serogroup D).271


Staphylococcus Members of the Foods that require considerable Food poisoning is often Symptoms of staphylococcal In most cases,
aureus (PP) genus handling during preparation or that attributed to the food poisoning usually appear treatment for S.
Staphylococcus are are kept at slightly staphylococcal within 1 to 6 hours after aureus infection is
gram-positive elevated temperatures after enterotoxin.283 ingestion. not necessary and
cocci. Currently, preparation are frequently involved The individual response to the complete recovery
the genus is in staphylococcal food poisoning. The toxin produced by toxin may vary and depends usually occurs after
composed of 32 The key foods associated with the bacteria is very upon the amount of cessation of
species and 15 staphylococcal food poisoning heat-stable and contaminated symptoms.290
subspecies.280 include meat and meat therefore not easily food eaten, the amount of toxin
products; poultry and egg products; destroyed by heat at ingested, and general health
salads such as egg, tuna, chicken, normal cooking status.286
potato, and macaroni; bakery temperatures. The toxin
products such as cream-filled can remain, despite the Nausea, vomiting, abdominal
pastries, cream pies, and chocolate organism being cramping,
éclairs; sandwich fillings; and milk destroyed.284 and diarrhea are the most
and dairyproducts.281 282 common symptoms.
There is considerable In more severe cases, headache,
variation in muscle cramping, and
susceptibility to the changes in blood pressure and
enterotoxin in adults. pulse rate may occur.287
Children and the elderly
have the highest degree Recovery generally takes two
of susceptibility.285 days. It is not unusual for
complete recovery to take three
days and sometimes
longer.288 289


Vibrio (PP): Vibrio are Pathogenic Vibrio are part of the Cholera is caused by V. While classic cholera is rare in Antimicrobial
*Vibrio cholerae members of the autochthonous microbial flora in cholerae 01.294 the US, the rice-water stool therapy reduces the
*Vibrio fluvialis Vibrionaceae brackish and marine environments in remains the characteristic frequency and
*Vibrio furnissii family and as such temperate or tropical regions. Gastroenteritis is symptom, among others and its duration of the
*Vibrio hollisae are gram negative classically associated infectious dose is quite large.296 diarrhea and shortens
*Vibrio metschnikovii rods.291 V. cholerae and V. mimicus may be with V. cholerae non- the post-infective
*Vibrio mimicus found in fresh water and in birds and 01, V. Gastroenteritis caused by other period of shedding of
*Vibrio There over 35 herbivores.293 parahaemolyticus, V. Vibrio sp. presents as diarrhea V.cholerae.298
parahaemolyticus species within the hollisae, V. mimicus, V. and may be accompanied by
*Vibrio species genus, of which fluvialis, V cramps, nausea, vomiting and Tetracycline or less
only about one metschnikovii, and V. fever.297 commonly
third are furnissii.295 furazolidone are
pathogenic for drugs of choice,
humans.292 though antibiotic
resistance is
increasing.299 300
Yeast not candida Yeast are Yeast are ubiquitous in the Less common yeast Disseminated infections may Currently, standard
(PP): unicellular, environment and can be found on such as those outlined include the intestinal tract and texts provide no
Blastoschizomyces: budding cells and fruits, vegetables and other plant in this section should are usually associated with specific antifungal
*Blastoschizomyces are usually round materials.302 only be considered immunosuppressive diseases or guidelines for GI
capitatus to oval in shape, opportunistic pathogens conditions such as overgrowth of the
Hansenula anomala though some forms They can also live as normal in the leukemia, organ transplant, fungi mentioned.316
317
Pichia ohmeri have demonstrated inhabitants both within and on the immunocompromised multiple myeloma, aplastic
Rhodotorula elongated and body.303 host.304 305 306 307 308 309 anemia, diabetes mellitus with
*Rhodotorula glutinis irregular shapes.301 310 311 312
ketoacidosis, ICU patients, Treatment is at the
*Rhodotorula rubra lymphoma, solid tumors and discretion of the
*Rhodotorula species AIDS.313 314 practitioner, and
Trichosporon Immunosuppressive therapy should be based upon
*Trichosporon such as corticosteroids, clinical symptoms
pullulans chemotherapeutic agents and and a positive
cyclosporine can also enhance reculture of the
*Trichosporon species
fungal overgrowth.315 organism.


Yersinia (PP): Yersinia are gram- Y. pseudotuberculosis is found Intestinal yersiniosis Watery and sometimes bloody Intestinal infections
*Yersinia negative naturally in numerous wild and may present in three stools, fever, vomiting, with Y. enterocolitica
enterocolitica enteropathogenic domestic mammals and birds. clinical forms: abdominal pain are common and Y.
*Yersinia bacilli that belong Y. enterocolitica can be found in all enteritis, terminal with Y. enterocolitica, pseudotuberculosis
pseudotuberculosis to the warm-blooded wild, domestic and ileitis, or mesenteric particularly in adults and less are usually self-
*Yersinia species Enterobacteriaceae pet animals and occasionally in some lymphadenitis causing frequently in children but rarely limiting and do not
family.318 fish. Pigs are important reservoirs for “pseudoappendicitis” in Y. pesudotuberculosis require antibiotic
the human strains of Y. and septicemia.322 infection which is more common therapy.
At present, there enterocolitica.320 in children exhibiting terminal In cases of
are at least 10 Y. entercolitica and Y. ileitis, lymphadenitis, and complicated
species within the Infections may be acquired by pseudotuberculosis are pseudoappendicitis.326 gastroenteritis,
Yersinia genus.319 ingestion of contaminated food or most commonly doxycycline or
water, or, rarely by direct person-to- isolated from cases of Animal and in-vitro studies have trimethoprim-
person transmission in schools and gastroenteritis. Both isolated an antigen designated sulfmethoxazole are
hospitals.321 would be considered Yersinia pseudotuberculosis the antibiotics of
significant isolates from mitogen (YPM) that is capable choice.332
stool. Both of these of increasing epithelial
organisms show permeability.327
preference for
lymphatic tissue and Chronic GI disease (eg
can spread via the intermediate colitis, UC, CD
bloodstream.323 may follow Y. enterocolitica
infection, though the exact role
Yersinia infection has this organism plays has not been
been shown to induce fully elucidated.328 329 330 331
chronic inflammatory
bowel disorders such as
chronic diarrhea and
IBD. Rheumatoid
arthritis, reactive
arthritis and unspecified
arthralgias have also
been noted after
Yersinia infection.324 325
* Susceptibility testing must guide treatment for all microbial and fungal organisms.

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Pathogenic Organism

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Pathogenic Organism Chart

Genus/Organism Description Habitat/Sources of Isolation Pathogenicity Symptoms *Treatment

© 2003 Great Smokies Diagnostic Laboratory

Genus/Organism Description Habitat/Sources of Isolation Pathogenicity Symptoms *Treatment

NB, it is estimated that only

© 2003 Great Smokies Diagnostic Laboratory

Genus/Organism Description Habitat/Sources of Isolation Pathogenicity Symptoms *Treatment

© 2003 Great Smokies Diagnostic Laboratory

Genus/Organism Description Habitat/Sources of Isolation Pathogenicity Symptoms *Treatment

© 2003 Great Smokies Diagnostic Laboratory

Genus/Organism Description Habitat/Sources of Isolation Pathogenicity Symptoms *Treatment

© 2003 Great Smokies Diagnostic Laboratory

Genus/Organism Description Habitat/Sources of Isolation Pathogenicity Symptoms *Treatment

© 2003 Great Smokies Diagnostic Laboratory

Genus/Organism Description Habitat/Sources of Isolation Pathogenicity Symptoms *Treatment

© 2003 Great Smokies Diagnostic Laboratory

© 2003 Great Smokies Diagnostic Laboratory

Genus/Organism Description Habitat/Sources of Isolation Pathogenicity Symptoms *Treatment

© 2003 Great Smokies Diagnostic Laboratory

Genus/Organism Description Habitat/Sources of Isolation Pathogenicity Symptoms *Treatment

© 2003 Great Smokies Diagnostic Laboratory

Genus/Organism Description Habitat/Sources of Isolation Pathogenicity Symptoms *Treatment

© 2003 Great Smokies Diagnostic Laboratory

Genus/Organism Description Habitat/Sources of Isolation Pathogenicity Symptoms *Treatment

© 2003 Great Smokies Diagnostic Laboratory

© 2003 Great Smokies Diagnostic Laboratory

Genus/Organism Description Habitat/Sources of Isolation Pathogenicity Symptoms *Treatment

© 2003 Great Smokies Diagnostic Laboratory

© 2003 Great Smokies Diagnostic Laboratory

Genus/Organism Description Habitat/Sources of Isolation Pathogenicity Symptoms *Treatment

© 2003 Great Smokies Diagnostic Laboratory

Genus/Organism Description Habitat/Sources of Isolation Pathogenicity Symptoms *Treatment

© 2003 Great Smokies Diagnostic Laboratory

Genus/Organism Description Habitat/Sources of Isolation Pathogenicity Symptoms *Treatment

© 2003 Great Smokies Diagnostic Laboratory

Genus/Organism Description Habitat/Sources of Isolation Pathogenicity Symptoms *Treatment

© 2003 Great Smokies Diagnostic Laboratory

© 2003 Great Smokies Diagnostic Laboratory

© 2003 Great Smokies Diagnostic Laboratory

© 2003 Great Smokies Diagnostic Laboratory

© 2003 Great Smokies Diagnostic Laboratory

© 2003 Great Smokies Diagnostic Laboratory

© 2003 Great Smokies Diagnostic Laboratory

© 2003 Great Smokies Diagnostic Laboratory

© 2003 Great Smokies Diagnostic Laboratory

© 2003 Great Smokies Diagnostic Laboratory

© 2003 Great Smokies Diagnostic Laboratory

© 2003 Great Smokies Diagnostic Laboratory

© 2003 Great Smokies Diagnostic Laboratory

© 2003 Great Smokies Diagnostic Laboratory

© 2003 Great Smokies Diagnostic Laboratory

© 2003 Great Smokies Diagnostic Laboratory

© 2003 Great Smokies Diagnostic Laboratory

© 2003 Great Smokies Diagnostic Laboratory

© 2003 Great Smokies Diagnostic Laboratory

© 2003 Great Smokies Diagnostic Laboratory

© 2003 Great Smokies Diagnostic Laboratory

© 2003 Great Smokies Diagnostic Laboratory

© 2003 Great Smokies Diagnostic Laboratory

© 2003 Great Smokies Diagnostic Laboratory

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