Klebsiela. Klebsiella pneumoniae

The genus Klebsiella, belonging to the family of enterobacteria, combines capsular bacteria that cause various diseases: pneumonia and purulent-inflammatory processes - K. pneumoniae, rhinoscleroma - K. rinoscleromatis, ozena (fetid rhinitis) - K. ozaenae.

Morphology. Klebsiella are short thick sticks, 0.6-6.0 × 0.3-1.5 µm in size with rounded ends. Motionless. Form a capsule. In smears, they are located singly, in pairs or in short chains.

cultivation. Klebsiella are facultative anaerobes. They grow well on simple nutrient media at 35-37 ° C. On dense media they form dome-shaped mucous colonies, on broth - intense turbidity.

Enzymatic properties. They ferment lactose, break down glucose and mannitol with the formation of acid and gas, decompose urea, do not form indole and hydrogen sulfide.

toxin formation. They have endotoxin. Their virulence depends on the presence of a capsule - non-capsular forms are less virulent.

Antigenic structure. Klebsiella contains capsular K- and somatic O-antigens. The combination of these antigens determines the belonging of cultures to certain serovars. Currently, 80 K- and 11 O-antigens are known.

Environmental resistance. Due to the presence of Klebsiella capsules, they are stable and persist for a long time in soil, water, and on household items. At 65°C they die within an hour. Sensitive to the action of solutions of disinfectants (chloramine, phenol, etc.). There is a high resistance to antibiotics.

Animal susceptibility. Under natural conditions, they cause diseases of various animals: cows, pigs, horses (mastitis, pneumonia, septicemia).

Sources of infection. With exogenous infection, the source of infection is a sick person and a healthy carrier.

Transmission routes. Contact-household (dirty hands, household items). In children's institutions and hospitals, the infection is often transmitted through linen, tools, and toys.

Pathogenesis. Klebsiella develops mostly as a secondary infection in individuals with reduced resistance and in newborns (premature). Bacteria from the upper respiratory tract and intestines penetrate into various organs and blood and cause purulent-inflammatory processes, sepsis, meningitis.

Immunity. Post-infection immunity is short-lived and develops only in relation to one specific pathogen (serovar).

Prevention. Compliance with the sanitary and hygienic regime in maternity hospitals, hospitals, children's institutions. Specific prophylaxis absent.

Treatment difficult due to the high resistance of Klebsiella to antibiotics. The most effective use of gentamicin, kanamycin, sometimes ampicillin.

Microbiological research

The purpose of the study: isolation and identification of Klebsiella from pathological material and environmental objects.

Research material

1. Phlegm.

2. Mucus from the pharynx, pus from the ear, wound discharge.

3. Bowel movements.

4. Washouts from environmental objects.

Basic research methods

1. Microbiological.

2. Serological.

Research progress

Second day of research

They make smears, stain according to Gram. In the presence of amnegative rods, mucous colonies (4-5) are selected and subcultured onto slant agar and Worfel-Ferguson medium (to isolate a pure culture) and Russell's combined medium (or medium with urea) to determine enzymatic properties and mobility. Strips of paper impregnated with reagents for the determination of indole formation and hydrogen sulfide are lowered into a test tube under the stopper.

Do a seeding from glucose agar on dense nutrient media for (if necessary) additional research.

Third day of research

With the growth of an immobile culture that ferments lactose, glucose, urea, which does not form indole and hydrogen sulfide, inoculation is done on media with citrate and malonate and smears to determine the presence of a capsule. In the presence of a capsule, an agglutination reaction is performed on glass with agglutinating K-sera. View additional sowing on dense nutrient media. You can give an approximate answer: "Klebsiella isolated."

Capsular bacteria- Klebsiella - found in the pharynx and nose mucus, secretions from the respiratory tract and lungs, on environmental objects. They belong to the family Enterobacteriaceae, genus Klebsiella. Klebsiella have the ability to form capsules both in the body and on nutrient media.

Klebsiella- thick short sticks measuring 2-5 * 0.3-1.25 microns, with rounded ends, motionless. Dispute does not form. In smears, they are arranged in pairs or singly, usually surrounded by a capsule, gram-negative. Grow well on simple nutrient media at a temperature of 35-37°C. On meat-peptone agar they form cloudy mucous colonies, in the broth - intense turbidity. The nature of growth on agar and enzymatic properties are given in table. 6. Klebsiella do not form exotoxins, contain endotoxins. Capsular bacteria include three antigens: capsular (K-antigen), somatic smooth (O-antigen), somatic rough (R-antigen); K- and O-antigens are carbohydrates, R-antigen is a protein.

The resistance of Klebsiella is quite high: at room temperature they persist for months, when heated to 65 ° C they die within an hour. Sensitive to the action of various disinfectants: chloramine solution, phenol, etc.

The virulence of Klebsiella is associated with the presence of capsules in them. Bacteria that have lost the capsule become non-virulent and are rapidly phagocytosed when introduced into the body of an animal. Capsular variants cause the death of mice 24-48 hours after infection with seeding of all organs.

In humans, Klebsiella leads to pneumonia, ozena and rhinoscleroma. Klebsiella pneumoniae (Friedlander's wand) causes bronchopneumonia in humans, which occurs with damage to one or more lobes of the lung.

Confluent foci and abscesses in the lung are possible. Lethality is high. Occasionally, Klebsiella pneumonia can cause pyemia, meningitis, appendicitis, cystitis, and mixed infections. Klebsiella ozaenae is the causative agent of the fetid rhinitis, which is found in Spain, India, China, and Japan. Cases of ozena are also known in the USSR. When the disease affects the nasal mucosa, pharynx, trachea, larynx, as well as the accessory cavities of the nose and turbinates. Ozena is characterized by the release of a viscous secret, which dries up with the formation of dense crusts that make breathing difficult and emit a fetid odor. The disease is transmitted by airborne droplets. Klebsiella rhinoscleromatis (Volkovich's stick - Frisch) causes a chronic granulomatous process on the skin, nasal mucosa, trachea, larynx, bronchi. Rhinoscleroma is a low-contagious chronic disease that occurs in Austria, Poland, and also in the USSR. Klebsiella rhinoscleroma are found intracellularly and extracellularly in scrapings from tissue nodules (granulomas) in the form of short sticks surrounded by a capsule.

Immunity. After the transferred disease unstable.

Microbiological diagnostics. It is carried out using microbiological and serological methods. Test material: sputum (in case of pneumonia), mucus from the throat, nose, trachea (in case of lake), pieces of tissue from granulomas (in case of rhinoscleroma).

Crops are made on meat-peptone or glycerol agar, as well as on differential media - bromthymol or bromcresol agar. Incubated at 37°C. After 24 hours, the growing mucous colonies are inoculated onto a slant agar. The enzymatic properties of the resulting pure culture are studied.

For the differentiation of capsular bacteria, it is also recommended to study the structure of young l colonies on a dish with meat-peptone agar. Pneumonia sticks are located in young colonies in a loop-like manner, rhinoscleroma sticks are concentric, ozena sticks are concentric and scattered (see Table 6).

Serological diagnosis is carried out by staging the complement fixation reaction and the agglutination reaction. As an auxiliary method, a skin allergy test is used, but it is less specific than serological reactions.

Prevention and treatment. Timely identification of patients and their hospitalization.

Antibiotics (streptomycin, chloramphenicol, neomycin, tetracycline), antimony preparations (solyusurmin), and vaccine therapy are prescribed for treatment. The vaccine is prepared from capsular strains by heating.

The textbook consists of seven parts. Part one - "General Microbiology" - contains information about the morphology and physiology of bacteria. Part two is devoted to the genetics of bacteria. The third part - "Microflora of the biosphere" - considers the microflora of the environment, its role in the cycle of substances in nature, as well as the human microflora and its significance. Part four - "The Doctrine of Infection" - is devoted to the pathogenic properties of microorganisms, their role in the infectious process, and also contains information about antibiotics and their mechanisms of action. Part five - "The Doctrine of Immunity" - contains modern ideas about immunity. The sixth part - "Viruses and the diseases they cause" - provides information about the main biological properties of viruses and the diseases they cause. Part seven - "Private Medical Microbiology" - contains information about the morphology, physiology, pathogenic properties of pathogens of many infectious diseases, as well as modern methods of their diagnosis, specific prevention and therapy.

The textbook is intended for students, graduate students and teachers of higher medical educational institutions, universities, microbiologists of all specialties and practitioners.

5th edition, revised and enlarged

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Genus Klebsiella belongs to the family Enterobacteriaceae. Unlike the vast majority of genera of this family, bacteria of the genus Klebsiella have the ability to form a capsule. To the genus Klebsiella includes several types. The main role in human pathology is played by the species Klebsiella pneumoniae, which is divided into three subspecies: K. pneumoniae subsp. pneumoniae, K. pneumoniae subsp. ozaenae And K. pneumoniae subsp. rhinoscleromatis. However, new species of Klebsiella have been identified in recent years ( K. oxytoca, K. mobilis, K. planticola, K. terrigena), which are still little studied and their role in human pathology is being specified. The genus name is given in honor of the German bacteriologist E. Klebs. Klebsiella is constantly found on the skin and mucous membranes of humans and animals. K. pneumoniae- a frequent causative agent of nosocomial infections, including mixed ones.

Klebsiella are gram-negative ellipsoid bacteria, they have the form of thick short rods with rounded ends, 0.3-0.6 × 0.6 in size. 1.5 - 6.0 microns, the capsule form has a size of 3 - 5? 5 - 8 µm. Sizes are subject to strong fluctuations, especially in Klebsiella pneumoniae. Flagella are absent, bacteria do not form spores, some strains have cilia. A thick polysaccharide capsule is usually visible; non-capsular forms can be obtained by exposing bacteria to low temperature, serum, bile, phages, antibiotics, and mutations. Arranged in pairs or singly.

Klebsiella grows well on simple nutrient media, facultative anaerobes, chemoorganotrophs. The optimum growth temperature is 35 - 37 °C, pH 7.2 - 7.4, but can grow at 12 - 41 °C. Able to grow on Simmons medium, i.e. use sodium citrate as the sole carbon source (except K. rhinoscleromatis). On dense nutrient media, they form cloudy mucous colonies, and in young 2–4-hour colonies, ozena bacteria are located in scattered concentric rows, rhinoscleromas are concentric, pneumonias are loop-shaped, which is easily determined by microscopy of a colony with low magnification and can be used to differentiate them. . When growing in the BCH, Klebsiella causes a uniform turbidity, sometimes with a mucous film on the surface; on semi-liquid media, growth is more abundant in the upper part of the medium.

Klebsiella ferment carbohydrates to form acid or acid and gas, and reduce nitrate to nitrite. Gelatin is not liquefied, indole and hydrogen sulfide are not formed. They have urease activity, do not always curdle milk. Least of all, biochemical activity is expressed in the causative agent of rhinoscleroma (Table 26).

Table 26

Biochemical signs of Klebsiella

Note. (+) - sign is positive; (–) – sign is absent; d - the sign is unstable.

Antigens. Klebsiella have O- and K-antigens. According to the O-antigen, Klebsiella is divided into 11 serotypes, and according to the capsular K-antigen - into 82. Serological typing of Klebsiella is based on the determination of K-antigens. A group-specific antigen was found in almost all strains of Klebsiella. Some K-antigens are related to K-antigens of streptococci, Escherichia and Salmonella. O-antigens related to O-antigens discovered E. coli.

Main pathogenicity factors Klebsiella are K-antigen, which suppresses phagocytosis, and endotoxin. Apart from them, K. pneumoniae can produce heat-labile enterotoxin - a protein similar in mechanism of action to the toxin of enterotoxigenic Escherichia coli. Klebsiella have pronounced adhesive properties.

Epidemiology. Klebsiellosis is the most common nosocomial infection. The source is a sick person and a bacteriocarrier. Both exogenous and endogenous infection is possible. The most common are food, airborne and contact-household. Transmission factors are most often food (especially meat and dairy), water, air. In recent years, the frequency of Klebsiellosis has increased, one of the reasons for this is an increase in the pathogenicity of the pathogen due to a decrease in the resistance of the human body. This is also facilitated by the widespread use of antibiotics that change the normal ratio of microorganisms in the natural biocenosis, immunosuppressants, etc. It should be noted that Klebsiella is highly resistant to various antibiotics.

Klebsiella is sensitive to the action of various disinfectants, at a temperature of 65 ° C they die within 1 hour. Quite stable in the external environment: the mucous capsule prevents the pathogen from drying out, so Klebsiella can survive in the soil, dust of wards, on equipment, furniture at room temperature for weeks and even for months.

Pathogenesis and clinic.K. pneumoniae most often cause a disease that proceeds as an intestinal infection and is characterized by an acute onset, nausea, vomiting, abdominal pain, diarrhea, fever and general weakness. The duration of the illness is 1-5 days. Klebsiella can cause damage to the respiratory system, joints, meninges, conjunctiva, urinary organs, as well as sepsis and purulent postoperative complications. The most severe is the generalized septic-pyemic course of the disease, often leading to death.

K. ozaenae affects the mucous membrane of the nose and its paranasal sinuses, causes their atrophy, inflammation is accompanied by the release of a viscous fetid secret. K. rhinoscleromatis affects not only the nasal mucosa, but also the trachea, bronchi, pharynx, larynx, while specific granulomas develop in the affected tissue, followed by sclerosis and the development of cartilaginous infiltrates. The course of the disease is chronic, death can occur against the background of obstruction of the trachea or larynx.

Post-infectious immunity fragile, is mainly cellular in nature. In a chronic disease, signs of GCHZ sometimes develop.

Laboratory diagnostics. The main diagnostic method is bacteriological. The material for sowing can be different: pus, blood, cerebrospinal fluid, feces, swabs from objects, etc. It is sown on the K-2 differential diagnostic medium (with urea, raffinose, bromthymol blue), large shiny mucous colonies with coloring grow in a day from yellow or green-yellow to blue. Next, the bacteria determine the mobility by sowing in Peshkov's medium and the presence of ornithine decarboxylase. These signs are not characteristic of Klebsiella. The final identification consists in studying the biochemical properties and determining the serogroup using the agglutination reaction of a live culture with K-sera. The isolated pure culture is tested for sensitivity to antibiotics.

Sometimes, an agglutination test or RSK with a standard O-Klebsiella antigen or with an autostrain can be used to diagnose Klebsiella.

Diagnostic value has a fourfold increase in antibody titers.

Prevention and treatment. Specific prophylaxis has not been developed. General prevention is reduced to strict observance of sanitary and hygienic standards for the storage of food products, strict observance of asepsis and antisepsis in medical institutions, as well as personal hygiene.

Treatment of Klebsiellesis according to clinical indications is carried out in a hospital. If the intestines are affected, antibiotics are not indicated. When dehydration occurs (the presence of an enterotoxin in the pathogen), saline solutions are administered orally or parenterally. In generalized and sluggish chronic forms, antibiotics are used (in accordance with the results of testing for sensitivity to them), autovaccines; carry out activities that stimulate immunity (autohemotherapy, pyrogen therapy, etc.).

The name is given in honor of E. Klebs. The genus Klebsiella includes two species: Klebsiella pneumoniae and Enterobacter. The first species is subdivided into two subspecies: K. ozenae, K. rinoscleromatis.

Morphology and physiology. Representatives of the species Klebsiella pneumoniae are short, thick, immobile gram-negative rods, which, unlike other enterobacteria, form pronounced polysaccharide capsules. Klebsiella, as well as other enterobacteria, are undemanding to nutrient media. They ferment glucose with acid and gas and use it and citrate as their sole carbon source and ammonia as their nitrogen source. Klebsiella subspecies are distinguished by biochemical characteristics. Unlike the Enterobacter species, K. pneumoniae lack flagella, do not synthesize ornithine decarboxylase, and ferment sorbitol. Differentiation of different types of Klebsiella is carried out on the basis of their unequal ability to ferment carbohydrates, form urease and lysine decarboxylase, utilize citrate and other features. Klebsiella form slimy colonies.

Klebsiella

Antigens. Klebsiella contain O- and K-antigens. In total, about 11 O-antigens and 70 K-antigens are known. The latter are represented by capsular polysaccharides. Serological identification of Klebsiella is based on their antigenic differences. The largest number of O- and K-antigens contain K. pneumoniae. Some O- and K-antigens of Klebsiella are related to O-antigens of Escherichia and Salmonella.

Pathogenicity and pathogenesis. The virulence of Klebsiella pneumonia is due to their adhesion associated with the capsular polysaccharide, pili and outer membrane protein, followed by reproduction and colonization of enterocytes. The capsule also protects bacteria from the action of phagocytic cells. When bacterial cells are destroyed, endotoxin (LPS) is released. In addition, pneumoniae Klebsiella secrete a thermostable enterotoxin that enhances fluid effusion into the lumen of the small intestine, which plays a significant role in the pathogenesis of acute respiratory disease, and membranotoxin with hemolytic activity. Klebsiella is the causative agent of pneumonia, OKZ, rhinoscleroma, ozena. They can also cause damage to the genitourinary organs, meninges of adults and children, toxic-septic conditions and acute respiratory infections in newborns. Klebsiella can cause nosocomial infections. Pneumonia caused by K. pneumoniae is characterized by the formation of multiple foci in the lobules of the lung, followed by their fusion and mucus of the affected tissue, which contains a large number of Klebsiella. Perhaps the formation of purulent foci in other organs and the development of sepsis. With scleroma caused by K. rhinoscleromatis, the nasal mucosa (rhinoscleroma), nasopharynx, trachea, and bronchi are affected. Granulomas are formed in the tissues with subsequent sclerotic changes. When the lake is caused by K. ozenae, the mucous membrane of the nose and adnexal cavities is affected, followed by atrophy of the turbinates and the release of a fetid secret.

Immunity. Klebsiella cause humoral and cellular immune response. However, the resulting antibodies do not have protective properties. The development of DTH is associated with the intracellular localization of Klebsiella.

Ecology and epidemiology. Klebsiellosis is an anthroponotic infection. The source of infection is patients and carriers. Infection occurs through the respiratory tract. Klebsiella are part of the intestinal biocenosis, found on the skin and mucous membranes. They are resistant to environmental factors and remain relatively long in soil, water, and indoors. In dairy products, they survive and multiply when stored in refrigerators. When heated, they die already at a temperature of 65 ° C, they are sensitive to solutions of conventional disinfectants.

Laboratory diagnostics. The diagnosis is based on the results of microscopy of smears from the test material (sputum, nasal mucus, etc.) and the isolation of a pure culture of the pathogen. Differentiation of Klebsiella and their identification is carried out according to morphological, biochemical and antigenic characteristics. Serodiagnosis is carried out in the RSC with the sera of patients and Klebsiella O-antigen.

Prevention and treatment. Specific vaccination against Klebsiella has not been developed. Antibiotics are used for treatment, of which third-generation cephalosporins are the most effective.

KLEBSIELLA (CAPSULAR BACTERIA)
Among pathogenic microorganisms there is a group of bacteria, which is characterized by the formation of a capsule not only in the body of a sick person, but also on artificial nutrient media. Therefore, these bacteria are called capsular. These include the causative agent of pneumonia - Friedlander's diplobacteria (Klebsiella pneumoniae), rhinoscleroma bacillus (Klebsiella rhinoscleromatis) and ozena bacillus (Klebsiella ozaenae).
Morphology and tinctorial properties. All microbes of this group are small sticks with rounded ends from 1 to 3 microns in length and from 0.5 to 0.8 microns in thickness. Often arranged in pairs. They do not form spores, they do not have flagella. Equipped with a mucous capsule (see Fig. 19 on the insert). Easily perceive aniline dyes, gram-negative.
Cultural and biochemical properties. On conventional nutrient media, capsular bacteria grow luxuriantly. The optimum growth temperature is 37°. Round, slimy grayish-white colonies form on agar plates. According to Elbert, ozena rods in a young colony (3-4 hours of growth) are located concentrically, pneumonia bacteria are looped. On slant agar form a grayish-white coating of mucous character. Diffuse growth is caused in the broth with the formation of a viscous mucous sediment at the bottom, and a mucous film on the surface. Gelatin is not liquefied. Ferment carbohydrates intermittently with the formation of acid, and sometimes gas. Rhinoscleroma stick does not ferment lactose (Elbert).
Pathogenicity for animals and humans. White mice are sensitive to capsular bacteria, which die 24-48 hours after parenteral administration of the culture.
Klebsiella pneumonia causes pneumonia in humans, purulent and fibrinous pleurisy, pericarditis, meningitis, sinusitis, etc. Rhinoscleroma stick affects the upper respiratory tract. The disease is expressed in the formation of chronic cartilaginous infiltrates in the skin and nasal mucosa, on the mucous membranes of the pharynx and larynx. For the affected tissue in rhinoscleroma, the presence of large Mikulich cells with pathogens contained in them is characteristic.
The ozena stick causes inflammation of the nasal mucosa with the release of a viscous mucopurulent secretion, which quickly dries up with the formation of crusts.
Microbiological diagnostics. Laboratory diagnosis of diseases caused by capsular bacteria is based on a bacterioscopic, bacteriological and experimental study of pathological material (sputum in pneumonia, nasal mucus in lakes, pieces of tissue in rhinoscleroma). The complement fixation test is used to diagnose rhinoscleroma.
The epidemiology of capsular infections has been little studied. There is no specific prevention. Treatment is carried out using streptomycin, tetracycline, neomycin and antimony preparations.

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