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Pathogenic bacteria are bacteria that can cause disease. This article focuses on the bacteria that are pathogenic to humans. Most species of bacteria are harmless and many are beneficial but others can cause infectious diseases. The number of these pathogenic species in humans is estimated to be fewer than a hundred. By contrast, several thousand species are part of the gut flora present in the digestive tract.

The body is continually exposed to many species of bacteria, including beneficial commensals, which grow on the skin and mucous membranes, and saprophytes, which grow mainly in the soil and in decaying matter. The blood and tissue fluids contain nutrients sufficient to sustain the growth of many bacteria. The body has defence mechanisms that enable it to resist microbial invasion of its tissues and give it a natural immunity or innate resistance against many microorganisms.

Pathogenic bacteria are specially adapted and endowed with mechanisms for overcoming the normal body defences, and can invade parts of the body, such as the blood, where bacteria are not normally found. Some pathogens invade only the surface epithelium, skin or mucous membrane, but many travel more deeply, spreading through the tissues and disseminating by the lymphatic and blood streams. In some rare cases a pathogenic microbe can infect an entirely healthy person, but infection usually occurs only if the body's defence mechanisms are damaged by some local trauma or an underlying debilitating disease, such as wounding, intoxication, chilling, fatigue, and malnutrition. In many cases, it is important to differentiate infection and colonization, which is when the bacteria are causing little or no harm.

Caused by Mycobacterium tuberculosis bacteria, one of the diseases with the highest disease burden is tuberculosis, which killed 1.4 million people in 2019, mostly in sub-Saharan Africa. Pathogenic bacteria contribute to other globally important diseases, such as pneumonia, which can be caused by bacteria such as Staphylococcus, Streptococcus and Pseudomonas, and foodborne illnesses, which can be caused by bacteria such as Shigella, Campylobacter, and Salmonella. Pathogenic bacteria also cause infections such as tetanus, typhoid fever, diphtheria, syphilis, and leprosy.

Pathogenic bacteria are also the cause of high infant mortality rates in developing countries. A GBD study estimated the global death rates from (33) bacterial pathogens, finding such infections contributed to one in 8 deaths (or ~7.7 million deaths), which could make it the second largest cause of death globally in 2019.

Most pathogenic bacteria can be grown in cultures and identified by Gram stain and other methods. Bacteria grown in this way are often tested to find which antibiotics will be an effective treatment for the infection. For hitherto unknown pathogens, Koch's postulates are the standard to establish a causative relationship between a microbe and a disease.

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Diseases

Each species has specific effect and causes symptoms in people who are infected. Some people who are infected with a pathogenic bacteria do not have symptoms. Immunocompromised individuals are more susceptible to pathogenic bacteria.7

Pathogenic susceptibility

Some pathogenic bacteria cause disease under certain conditions, such as entry through the skin via a cut, through sexual activity or through compromised immune function.

Some species of Streptococcus and Staphylococcus are part of the normal skin microbiota and typically reside on healthy skin or in the nasopharyngeal region. Yet these species can potentially initiate skin infections. Streptococcal infections include sepsis, pneumonia, and meningitis.8 These infections can become serious creating a systemic inflammatory response resulting in massive vasodilation, shock, and death.9

Other bacteria are opportunistic pathogens and cause disease mainly in people with immunosuppression or cystic fibrosis. Examples of these opportunistic pathogens include Pseudomonas aeruginosa, Burkholderia cenocepacia, and Mycobacterium avium.1011

Intracellular

Obligate intracellular parasites (e.g. Chlamydophila, Ehrlichia, Rickettsia) are only able to grow and replicate inside other cells. Infections due to obligate intracellular bacteria may be asymptomatic, requiring an incubation period. Examples of obligate intracellular bacteria include Rickettsia prowazekii (typhus) and Rickettsia rickettsii, (Rocky Mountain spotted fever).

Chlamydia are intracellular parasites. These pathogens can cause pneumonia or urinary tract infection and may be involved in coronary heart disease.12

Other groups of intracellular bacterial pathogens include Salmonella, Neisseria, Brucella, Mycobacterium, Nocardia, Listeria, Francisella, Legionella, and Yersinia pestis. These can exist intracellularly, but can exist outside host cells.

Infections in specific tissue

Bacterial pathogens often cause infection in specific areas of the body. Others are generalists.

Mechanisms of damage

The symptoms of disease appear as pathogenic bacteria damage host tissues or interfere with their function. The bacteria can damage host cells directly or indirectly by provoking an immune response that inadvertently damages host cells,21 or by releasing toxins.22

Direct

Once pathogens attach to host cells, they can cause direct damage as the pathogens use the host cell for nutrients and produce waste products.23 For example, Streptococcus mutans, a component of dental plaque, metabolizes dietary sugar and produces acid as a waste product. The acid decalcifies the tooth surface to cause dental caries.24

Toxin production

Endotoxins are the lipid portions of lipopolysaccharides that are part of the outer membrane of the cell wall of gram-negative bacteria. Endotoxins are released when the bacteria lyses, which is why after antibiotic treatment, symptoms can worsen at first as the bacteria are killed and they release their endotoxins. Exotoxins are secreted into the surrounding medium or released when the bacteria die and the cell wall breaks apart.25

Indirect

An excessive or inappropriate immune response triggered by an infection may damage host cells.26

Survival in host

Nutrients

Iron is required for humans, as well as the growth of most bacteria. To obtain free iron, some pathogens secrete proteins called siderophores, which take the iron away from iron-transport proteins by binding to the iron even more tightly. Once the iron-siderophore complex is formed, it is taken up by siderophore receptors on the bacterial surface and then that iron is brought into the bacterium.27

Bacterial pathogens also require access to carbon and energy sources for growth. To avoid competition with host cells for glucose which is the main energy source used by human cells, many pathogens including the respiratory pathogen Haemophilus influenzae specialise in using other carbon sources such as lactate that are abundant in the human body 28

Identification

Typically identification is done by growing the organism in a wide range of cultures which can take up to 48 hours. The growth is then visually or genomically identified. The cultured organism is then subjected to various assays to observe reactions to help further identify species and strain.29

Treatment

Main article: Antibiotics

See also: overview list below

Bacterial infections may be treated with antibiotics, which are classified as bacteriocidal if they kill bacteria or bacteriostatic if they just prevent bacterial growth. There are many types of antibiotics and each class inhibits a process that is different in the pathogen from that found in the host. For example, the antibiotics chloramphenicol and tetracyclin inhibit the bacterial ribosome but not the structurally different eukaryotic ribosome, so they exhibit selective toxicity.30 Antibiotics are used both in treating human disease and in intensive farming to promote animal growth. Both uses may be contributing to the rapid development of antibiotic resistance in bacterial populations.31 Phage therapy, using bacteriophages can also be used to treat certain bacterial infections.32

Prevention

Infections can be prevented by antiseptic measures such as sterilizing the skin prior to piercing it with the needle of a syringe and by proper care of indwelling catheters. Surgical and dental instruments are also sterilized to prevent infection by bacteria. Disinfectants such as bleach are used to kill bacteria or other pathogens on surfaces to prevent contamination and further reduce the risk of infection. Bacteria in food are killed by cooking to temperatures above 73 °C (163 °F).

List of genera and microscopy features

Many genera contain pathogenic bacterial species. They often possess characteristics that help to classify and organize them into groups. The following is a partial listing.

GenusSpeciesGram stainingShapeOxygen requirementIntra/Extracellular
Bacillus33PositiveRodsFacultative anaerobicExtracellular
Bartonella34NegativeRodsAerobicFacultative intracellular
Bordetella35NegativeSmall coccobacilliAerobicExtracellular
Borrelia38Negative, stains poorlySpirocheteAnaerobicExtracellular
Brucella39NegativeCoccobacilliAerobicIntracellular
Campylobacter40NegativeSpiral rods41 coccoid in older cultures42Microaerophilic43Extracellular
Chlamydia and Chlamydophila44(not Gram-stained)Small, round, ovoidFacultative or strictly aerobicObligate intracellular
Clostridium45PositiveLarge, blunt-ended rodsObligate anaerobicExtracellular
Corynebacterium46Positive (unevenly)RodsMostly facultative anaerobicExtracellular
Enterococcus5051PositiveCocciFacultative AnaerobicExtracellular
Escherichia525354NegativeRodsFacultative anaerobicExtracellular or Intracellular
Francisella55NegativeCoccobacillusStrictly aerobicFacultative intracellular
HaemophilusNegativeCoccobacilli to long and slender filamentsFacultative anaerobic 5 - 10% CO2Extracellular
HelicobacterNegativeSpiral rodMicroaerophileExtracellular
Legionella59Negative, stains poorlyCocobacilliAerobicFacultative intracellular
Leptospira6061Negative, stains poorlySpirocheteStrictly aerobicExtracellular
Listeria62Positive, darklySlender, short rodsFacultative AnaerobicFacultative intracellular
Mycobacterium63(none)Long, slender rodsAerobicIntracellular
Mycoplasma64(none)Indistinct 'fried egg' appearance, no cell wallMostly facultative anaerobic; M. pneumoniae strictly aerobicExtracellular
Neisseria6566NegativeKidney bean-shapedAerobicGonococcus: facultative intracellularN. meningitidis: extracellular
Pseudomonas6768NegativeRodsObligate aerobicExtracellular
Rickettsia69Negative, stains poorlySmall, rod-like coccobacillaryAerobicObligate intracellular
Salmonella70NegativeRodsFacultative anaerobicFacultative intracellular
Shigella7172NegativeRodsFacultative anaerobicExtracellular
Staphylococcus73Positive, darklyRound cocciFacultative anaerobicExtracellular, facultative intracellular
Streptococcus74PositiveOvoid to sphericalFacultative anaerobicExtracellular
Treponema75Negative, stains poorlySpirocheteAerobicExtracellular
Ureaplasma76Stains poorly77Indistinct, 'fried egg' appearance, no cell wallAnaerobicExtracellular
Vibrio7879NegativeSpiral with single polar flagellumFacultative anaerobicExtracellular
Yersinia8081Negative, bipolarlySmall rodsFacultative anaerobeIntracellular

List of species and clinical characteristics

This is description of the more common genera and species presented with their clinical characteristics and treatments.

Species of human pathogenic bacteria
SpeciesTransmissionDiseasesTreatmentPrevention
Actinomyces israeliiOral flora82Actinomycosis:83 painful abscesses and cysts MRSA in the mouth, lungs,8485 or gastrointestinal tract.86Prolonged penicillin G and drainage87
Bacillus anthracis

Contact with cattle, sheep, goats and horses88Spores enter through inhalation or through abrasions89

Anthrax: pulmonary, gastrointestinal and/or cutaneous symptoms.90

In early infection:91

PenicillinDoxycyclineCiprofloxacinRaxibacumab92

Anthrax vaccine93Autoclaving of equipment94

Bacteroides fragilisGut flora95Abscesses in gastrointestinal tract, pelvic cavity and lungs96metronidazole97Wound care98

Aspiration prevention99

Bordetella pertussis

Contact with respiratory droplets expelled by infected human hosts.100

Whooping cough101102Secondary bacterial pneumonia103

Macrolides104 such as erythromycin,105106 before paroxysmal stage107

Pertussis vaccine,108109 such as in DPT vaccine110111

BorreliaB. burgdorferi112113

B. garinii114B. afzelii115

Ixodes hard ticks Reservoir in mice, other small mammals, and birds116

Lyme disease117118

Doxycycline for adults, amoxicillin for children, ceftriaxone for neurological involvement119

Wearing clothing that limits skin exposure to ticks.120Insect repellent.121Avoid areas where ticks are found.122

B. recurrentis123

and others124

Pediculus humanus corporis body louse (B. recurrentis only) and Ornithodoros soft ticks125Relapsing feverPenicillin, tetracycline, doxycycline126Avoid areas where ticks are found127

Better access to washing facilities128Reduce crowding129Pesticides130

BrucellaB. abortus

B. canisB. melitensisB. suis

Direct contact with infected animal131Oral, by ingestion of unpasteurized milk or milk products132

Brucellosis: mainly fever, muscular pain and night sweats

doxycycline133streptomycin or gentamicin134

Campylobacter jejuni

Fecal–oral from animals (mammals and fowl)135136Uncooked meat (especially poultry)137138Contaminated water139

Treat symptoms143Fluoroquinolone144 such as ciprofloxacin145 in severe cases146

Good hygiene147Avoiding contaminated water148Pasteurizing milk and milk products149Cooking meat (especially poultry)150

ChlamydiaC. pneumoniae

Respiratory droplets151152

Atypical pneumonia153

Doxycycline154155Erythromycin156157

None158
C. trachomatis

vaginal sex159oral sex160anal sex161Vertical from mother to newborn(ICN)162Direct or contaminated surfaces and flies (trachoma)163

Trachoma164165Neonatal conjunctivitis166167Neonatal pneumonia168169Nongonococcal urethritis (NGU)170171Urethritis172173Pelvic inflammatory disease174175Epididymitis176177Prostatitis178179Lymphogranuloma venereum (LGV)180181

Erythromycin182183 (adults)184Doxycycline185186 (infants and pregnant women)187

Erythromycin or silver nitrate in newborn's eyes188Safe sex189Abstinence190

Chlamydophila psittaciInhalation of dust with secretions or feces from birds (e.g. parrots)Psittacosis, mainly atypical pneumonia

Tetracycline191Doxycycline192Erythromycin193

-
ClostridiumC. botulinumSpores from soil,194195 persevere in canned food, smoked fish and honey196

Botulism: Mainly muscle weakness and paralysis197

Antitoxin198199 Penicillin200 Hyperbaric oxygen201 Mechanical ventilation202

Proper food preservation techniques

C. difficile

Gut flora,203204 overgrowing when other flora is depleted205

Pseudomembranous colitis206207

Discontinuing responsible antibiotic208209Vancomycin or metronidazole if severe210211

Fecal bacteriotherapy
C. perfringens

Spores in soil212213 Vaginal flora and gut flora214

Anaerobic cellulitis215216Gas gangrene217218Acute food poisoning219220

Gas gangrene:

Debridement or amputation221222 Hyperbaric medicine223224High doses of doxycycline225 or penicillin G226227 and clindamycin228Food poisoning:Supportive care is sufficient229

Appropriate food handling230
C. tetani

Spores in soil, skin penetration through wounds231232

Tetanus: muscle spasms233

Tetanus immune globulin234235Sedatives236Muscle relaxants237Mechanical ventilation238239 Penicillin or metronidazole240

Tetanus vaccine (such as in the DPT vaccine)241

Corynebacterium diphtheriae

respiratory dropletspart of human flora

Diphtheria: Fever, sore throat and neck swelling, potentially narrowing airways.242

Horse serum antitoxinErythromycinPenicillin

DPT vaccine

EhrlichiaE. canis243

E. chaffeensis244

Dog tick245Ehrlichiosis:246 headache, muscle aches, and fatigue
EnterococcusE. faecalis

E. faecium

Part of gut flora,249 opportunistic or entering through GI tract or urinary system wounds250

Bacterial endocarditis,251 biliary tract infections,252 urinary tract infections253

Ampicillin (combined with aminoglycoside in endocarditis)254Vancomycin255

No vaccineHand washing and other nosocomial prevention

EscherichiaE. coli (generally)UTI:268

(resistance-tests are required first)

Meningitis:269

Diarrhea:270

  • Antibiotics above shorten duration
  • Electrolyte and fluid replacement
(no vaccine or preventive drug)271
  • Cooking ground beef and pasteurizing milk against O157:H7272
  • Hand washing and disinfection273
Enterotoxigenic E. coli (ETEC)
Enteropathogenic E. coli
  • Diarrhea in infants280
Enteroinvasive E.coli (EIEC)
Enterohemorrhagic (EHEC), including E. coli O157:H7
  • Reservoir in cattle283
Francisella tularensis
  • vector-borne by arthropods288
  • Infected wild or domestic animals, birds or house pets289
Tularemia: Fever, ulceration at entry site and/or lymphadenopathy.290 Can cause severe pneumonia.291
  • Avoiding insect vectors294
  • Precautions when handling wild animals or animal products295
Haemophilus influenzae
  • Droplet contact296
  • Human flora of e.g. upper respiratory tract297
Meningitis:306

(resistance-tests are required first)

Helicobacter pylori
  • Colonizing stomach312
  • Unclear person-to-person transmission313
(No vaccine or preventive drug)319
Klebsiella pneumoniae
Legionella pneumophila(no vaccine or preventive drug)340

Heating water341

Leptospira species
  • Food and water contaminated by urine from infected wild or domestic animals. Leptospira survives for weeks in fresh water and moist soil.342
Vaccine not widely used347

Prevention of exposure349

Listeria monocytogenes(no vaccine)364
  • Proper food preparation and handling365
MycobacteriumM. leprae
  • Prolonged human-human contact, e.g. through exudates from skin lesions to abrasion of other person366
Tuberculoid form:

Lepromatous form:

M. tuberculosis
  • Droplet contact372

(difficult, see Tuberculosis treatment for more details)374

Standard "short" course:375

Mycoplasma pneumoniae
NeisseriaN. gonorrhoeaeUncomplicated gonorrhea:394

Ophthalmia neonatorum:

(No vaccine)403
N. meningitidis
Pseudomonas aeruginosaOpportunistic;420 Infects damaged tissues or people with immunodeficiency.421Pseudomonas infection:422(no vaccine)440
Nocardia asteroidesIn soil442Nocardiosis:443 Pneumonia, endocarditis, keratitis, neurological or lymphocutaneous infectionTMP/SMX444
Rickettsia rickettsii(no preventive drug or approved vaccine)453
SalmonellaS typhi
Other Salmonella species

e.g. S. typhimurium467

  • Fecal–oral468
  • Food contaminated by fowl469 (e.g. uncooked eggs)470 or turtles471
(No vaccine or preventive drug)487
  • Proper sewage disposal488
  • Food preparation489
  • Good personal hygiene490
ShigellaS. sonnei491

S. dysenteriae492

  • Protection of water and food supplies499
  • Vaccines are in trial stage500
Staphylococcusaureus
  • Human flora on mucosae in e.g. anterior nares, skin and vagina,501502 entering through wound
Coagulase-positive staphylococcal infections:(no vaccine or preventive drug)
  • Barrier precautions, washing hands and fomite disinfection in hospitals
epidermidisHuman flora in skin,523524 anterior nares525 and mucous membranes526None533
saprophyticusPart of normal vaginal flora534None538
StreptococcusagalactiaeHuman flora in vagina,539540 urethral mucous membranes,541 rectum542None555
pneumoniae
  • Respiratory droplets
  • Human flora in nasopharynx556 (spreading in immunocompromised)557
  • 23-serotype vaccine for adults (PPV)565566
  • Heptavalent conjugated vaccine for children (PCV)567
pyogenes
  • Respiratory droplets568
  • Direct physical contact with impetigo lesions569
No vaccine588
  • Rapid antibiotic treatment helps prevent rheumatic fever589
viridansOral flora,590 penetration through abrasionsPenicillin G594
Treponema pallidum subspecies pallidum
  • Penicillin offered to recent sexual partners608
  • Antibiotics to pregnant women if risk of transmitting to child609
  • No vaccine available610
  • Safe sex611
Vibrio cholerae
Yersinia pestisPlague:

Genetic transformation

Of the 59 species listed in the table with their clinical characteristics, 11 species (or 19%) are known to be capable of natural genetic transformation.633 Natural transformation is a bacterial adaptation for transferring DNA from one cell to another. This process includes the uptake of exogenous DNA from a donor cell by a recipient cell and its incorporation into the recipient cell's genome by recombination. Transformation appears to be an adaptation for repairing damage in the recipient cell's DNA. Among pathogenic bacteria, transformation capability likely serves as an adaptation that facilitates survival and infectivity.634 The pathogenic bacteria able to carry out natural genetic transformation (of those listed in the table) are Campylobacter jejuni, Enterococcus faecalis, Haemophilus influenzae, Helicobacter pylori, Klebsiella pneumoniae, Legionella pneumophila, Neisseria gonorrhoeae, Neisseria meningitidis, Staphylococcus aureus, Streptococcus pneumoniae and Vibrio cholerae.

See also

Notes

References

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