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__NOTOC__
{{Proteus infection}}
{{Taxobox
{{Taxobox
| color = lightgrey
| color = lightgrey
| name = ''Proteus''
| name = ''Proteus''
| image = Proteus_McConkey.jpg
| image_width = 240px
| image_caption = [[Proteus vulgaris]] growth in [[MacConkey agar]] culture plate
| domain= [[Bacteria]]
| domain= [[Bacteria]]
| phylum = [[Proteobacteria]]
| phylum = [[Proteobacteria]]
Line 21: Line 20:
etc.
etc.
}}
}}
{{SI}}
{{About0|Proteus infection}}
 
{{CMG}}
{{EH}}
==Overview==
 
''Proteus'' is a urease-producing, motile, nitrite-reducing, hydrogen sulfide-producing, catalase-positive, facultatively anaerobic, Gram-negative bacillus. It can be found in soil, water, and fecal matter. It inhabits the intestinal tracts of humans and animals, and is considered an opportunistic pathogen of humans. Transmission to the human host (usually urinary tract) typically occurs via self-contamination.
'''''Proteus''''' is a genus of [[Gram-negative]] [[Proteobacteria]], which includes [[pathogens]] responsible for many [[human]] [[urinary tract infection]]s.<ref name=Barron>{{cite book | author = Guentzel MN | title = Escherichia, Klebsiella, Enterobacter, Serratia, Citrobacter, and Proteus. ''In:'' Barron's Medical Microbiology ''(Barron S ''et al'', eds.)| edition = 4th ed. | publisher = Univ of Texas Medical Branch | year = 1996 | id = [http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=mmed.section.1472 (via NCBI Bookshelf)] ISBN 0-9631172-1-1 }}</ref> ''Proteus'' species do not usually ferment [[lactose]], but have shown to be capable lactose fermenters depending on the species in a [[TSI]] test, Triple Sugar Iron. They are [[oxidase]] negative, and [[urease]] positive; some species are [[Motility|motile]].<ref name=Sherris>{{cite book | author = Ryan KJ; Ray CG (editors) | title = Sherris Medical Microbiology | edition = 4th ed. | publisher = McGraw Hill | year = 2004 | id = ISBN 0-8385-8529-9 }}</ref>
==Taxonomy==
 
Kingdom: Bacteria; Phylum: Proteobacteria; Class: Gamma proteobacteria; Order: Enterobacteriales; Family: Enterobacteria; Genus: Proteus; Species: ''Proteus mirabilis''
==Pathogenesis==
==Genome==
Three species&mdash;''[[Proteus vulgaris|P. vulgaris]]'', ''[[Proteus mirabilis|P. mirabilis]]'', and ''[[Proteus penneri|P. penneri]]''&mdash;are [[Opportunistic infection|opportunistic]] human [[pathogen]]s.
*''Proteus'' contains more than 3,658 coding sequences with 7 rRNA loci.<ref name="pmid18375554">{{cite journal| author=Pearson MM, Sebaihia M, Churcher C, Quail MA, Seshasayee AS, Luscombe NM et al.| title=Complete genome sequence of uropathogenic Proteus mirabilis, a master of both adherence and motility. | journal=J Bacteriol | year= 2008 | volume= 190 | issue= 11 | pages= 4027-37 | pmid=18375554 | doi=10.1128/JB.01981-07 | pmc=PMC2395036 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18375554  }} </ref>
===Antimicrobial regimen===
*Total genome length is 4.063 Mb (28.8% GC content).<ref name="pmid18375554">{{cite journal| author=Pearson MM, Sebaihia M, Churcher C, Quail MA, Seshasayee AS, Luscombe NM et al.| title=Complete genome sequence of uropathogenic Proteus mirabilis, a master of both adherence and motility. | journal=J Bacteriol | year= 2008 | volume= 190 | issue= 11 | pages= 4027-37 | pmid=18375554 | doi=10.1128/JB.01981-07 | pmc=PMC2395036 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18375554  }} </ref>
:* '''Indole positive Proteus species'''<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
*''Proteus'' contains a single plasmid that contains 26,298 nucleotides.<ref name="pmid18375554">{{cite journal| author=Pearson MM, Sebaihia M, Churcher C, Quail MA, Seshasayee AS, Luscombe NM et al.| title=Complete genome sequence of uropathogenic Proteus mirabilis, a master of both adherence and motility. | journal=J Bacteriol | year= 2008 | volume= 190 | issue= 11 | pages= 4027-37 | pmid=18375554 | doi=10.1128/JB.01981-07 | pmc=PMC2395036 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18375554  }} </ref>
::* Preferred regimen (1): [[Ceftriaxone]] 1 g IV q24h
::* Preferred regimen (2): [[Imipenem]] 500 mg IV q6h
::* Preferred regimen (3): [[Ciprofloxacin]] 400 mg IV q12h or 250-500 mg PO bid
::* Preferred regimen (4): [[Levofloxacin]] 500 mg IV/PO q24h
 
__NOTOC__
{{Taxobox
| color = lightgrey
| name = ''Proteus vulgaris''
| image = Proteus McConkey.jpg
| image_caption = 24h old culture
| regnum = [[Bacterium|Bacteria]]
| phylum = [[Proteobacteria]]
| classis = Gamma Proteobacteria
| ordo = [[Enterobacteriaceae|Enterobacteriales]]
| familia = Enterobacteriaceae
| genus = ''[[Proteus (bacterium)|Proteus]]''
| species = '''''P. vulgaris'''''
| binomial = ''Proteus vulgaris''
| binomial_authority = [[Gustav Hauser|Hauser]] 1885
}}


'''''Proteus vulgaris''''' is a [[Bacillus (shape)|rod-shaped]], nitrate-reducing, indole+ and catalase-positive, hydrogen sulfide-producing, [[gram-negative bacteria|Gram-negative bacterium]] that inhabits the intestinal tracts of humans and animals. It can be found in soil, water, and fecal matter. It is grouped with the [[Enterobacteriaceae]] and is an opportunistic pathogen of humans. It is known to cause [[urinary tract infection]]s and [[wound infection]]s.
==Microbiological Characteristics==
*''Proteus'' is a urease-producing, motile, nitrite-reducing, hydrogen sulfide-producing, catalase-positive, facultatively anaerobic, Gram-negative bacillus.
*It grows optimally at 40 °C (104 °F).
*It produces [[hydrogen sulfide]] gas, and forms clear films on growth media. It is [[Motility|motile]], possessing peritrichous [[flagella]], and is known for its swarming ability. It is commonly found in the intestinal tracts of humans. ''P. mirabilis'' is not pathogenic in [[guinea pig]]s or chickens.
*Characteristically, ''Proteus'' can inhibit the growth of other strains in culture media, resulting in a macroscopically visible line (Dienes line) of reduced bacterial growth where two swarming strains intersect.
*The following table summarizes the microbiological characteristics of ''Proteus'':
{| {{table}}
| align="center" style="background:#f0f0f0;"|'''Test'''
| align="center" style="background:#f0f0f0;"|'''Result'''
|-
| Indole||Negative
|-
| Nitrate reductase||Positive (no formation of gas bubbles)
|-
| Methyl red||Positive
|-
| Voges-Proskauer||Negative (may be positive)
|-
| Catalase||Positive
|-
| Cytochrome oxidase||Negative
|-
| Phenylalanine deaminase||Positive
|-
| Tryptophan||Negative
|-
| Urea (Harnstoff test) ||Positive
|-
| Casein||Negative
|-
| Starch||Negative
|-
| Hydrogen sulfide||Positive
|-
| Citrate agar||Negative
|-
| Ornithine decarboxylase||Positive
|-
| Lysine decarboxylase||Negative
|-
| Glucose fermentation||Positive
|-
|Amygdalin fermentation||Positive
|-
|Mannitol fermentation||Negative
|-
|Lactose fermentation||Negative
|}


The term [[Proteus]] signifies changeability of form, as personified in the Homeric poems in Proteus, "the old man of the sea", who tends the sealflocks of Poseidon and has the gift of endless transformation.  The first use of the term “Proteus” in bacteriological nomenclature was made by Hauser (1885), who described under this term three types of organisms which he isolated from putrefied meat.  One of the three species Hauser identified was ''Proteus vulgaris'', so this organism has a long history in microbiology.
==Natural Reservoir==
 
*''Proteus'' can be found in soil, water, and fecal matter.
Over the past two decades, the genus ''Proteus'', and in particular ''P. vulgaris'', has undergone a number of major taxonomic revisions.  In 1982, ''P. vulgaris'' was separated into three biogroups on the basis of [[indole]] production.  Biogroup one was indole negative and represented a new species, ''P. penneri'', while biogroups two and three remained together as ''P. vulgaris''.
* It inhabits the intestinal tracts of humans and animals, and is considered an opportunistic pathogen of humans.
 
== Lab identification ==
 
According to laboratory fermentation tests, ''P. vulgaris''  ferments glucose and amygdalin, but does not ferment mannitol or lactose.  ''P. vulgaris'' also tests positive for the methyl red (mixed acid fermentation) test and is also an extremely motile organism.
 
When ''P. vulgaris'' is tested using the API 20E identification system<ref>{{cite web |url=http://www.rlc.dcccd.edu/mathsci/reynolds/micro/lab_manual/API.html |archiveurl=http://web.archive.org/web/20081107051850/http://www.rlc.dcccd.edu/mathsci/reynolds/micro/lab_manual/API.html |archivedate=7 November 2008 |title=API Test Strips}}</ref> it produces positive results for sulfur reduction, urease production, tryptophan deaminase production, indole production, sometimes positive gelatinase activity, and saccharose fermentation, and negative results for the remainder of the tests on the testing strip.
 
It is referenced in the [[Analytical Profile Index]] using the nine-digit code: 047602157
 
The optimal growing conditions of this organism is in a facultative anaerobic environment with an average temperature of about 40°C.
 
The Becton/Dickinson BBL Enterotube II  system for identification of members of the family Enterobacteriaceae inoculated with ''P. vulgaris'' may yield the following results:
*Positive for glucose fermentation (with gas production)
*Negative for lysine and ornithine
*Positive for hydrogen sulfide production and indole production
*Negative for adonitol and lactose
*Negative for arabinose, sorbitol and dulcitol
*Positive for the phenylalanine test and the Harnstoff urea test
''P. vulgaris'' can test positive or negative for citrate.  All combine for a "Biocode ID of 31407" for use in the Interpretation Guide/Computer Coding and Identification System. ''P. vulgaris'' can also test urease negative in solid media (such as in Enterotube), but will be urease positive in liquid media. The CCIS code will still identify it with a negative urease test.
 
== ''Proteus'' infections ==
=== Etiology and epidemiology ===
*Nosocomial infections
*''P. mirabilis'' causes 90% of ''Proteus'' infections.
*''P. vulgaris'' and ''P. penneri'' are easily isolated from individuals in long-term care facilities and hospitals and from patients with underlying diseases or compromised immune systems.
*Patients with recurrent infections, those with structural abnormalities of the urinary tract, those who have had urethral instrumentation, and those whose infections were acquired in the hospital have an increased frequency of infection caused by ''Proteus'' and other organisms (e.g., ''Klebsiella'', ''Enterobacter'', ''Pseudomonas'', enterococci, and staphylococci)
 
<!-- format convert to text or at least readable === Pathogenesis and virulence ===
''motility''
'''flagella'''
 
''adherence factors''<br />
'''Fimbriae'''—facilitate adherence and thus enhance the capacity of the organism to produce disease
 
''inflammatory response''<br />
'''IL-6/IL-8 secretion'''—attachment to uroepithelial cells initiates secretion
'''apoptosis and epithelial cell desquamation'''
'''pyelonephritis'''—Bacterial production of urease increases risk
'''bacteremia & sepsis'''—bacterial endotoxin (LPS)
 
''Survival''
'''urease production'''—alkalinize the urine by hydrolyzing urea to ammonia makes proteus effective in producing an environment in which it can survive. -->
=== Clinical expression ===
Enterobacteriaceae (of which ''Proteus ''is a member) and ''Pseudomonas'' species are the micro-organisms most commonly responsible for Gram-negative bacteremia and sepsis.
 
The presence of the sepsis syndrome associated with a urinary tract infection (UTI) should raise the possibility of urinary tract obstruction. This is especially true of patients who reside in long-term care facilities, who have long-term indwelling urethral catheters, or who have a known history of urethral anatomic abnormalities.
 
;UTI obstruction
Urease production leads to precipitation of organic and inorganic compounds, which leads to struvite stone formation. Struvite stones are composed of a combination of magnesium ammonium phosphate (struvite) and calcium carbonate-apatite.  Struvite stone formation can be sustained only when ammonia production is increased and the urine pH is elevated to decrease the solubility of phosphate. Both of these requirements can occur only when urine is infected with a urease-producing organism such as ''Proteus''. Urease metabolizes urea into ammonia and carbon dioxide: urea 2 NH<sub>3</sub> + CO<sub>2</sub>. The ammonia/ammonium buffer pair has a pK of 9.0, resulting in the combination of highly alkaline, ammonia-rich urine.
 
Symptoms attributable to struvite stones are uncommon. More often, women present with UTI, flank pain, or hematuria, and are found to have a persistently alkaline urine pH (>7.0).
 
== Treatments ==
Known antibiotics to which ''P. vulgaris'' is sensitive:
 
Ciprofloxacin<br />
Ceftazidime<br />
Netilmicin<br />
Sublactam or cefoperazone<br />
Meropenem<br />
Piperacillin/tazobactam<br />
Unasyn
 
Antibiotics should be introduced in much higher doses than "normal" when ''P. vulgaris'' has infected the sinus or respiratory tissues; for example, ciprofloxacin should be introduced at a level of at least 2000&nbsp;mg per day orally in such a situation, rather than the "standard" 1000&nbsp;mg per day.
 
[[Category:Infectious Disease Project]]
 
==See also==
* [[Proteus OX19|''Proteus'' OX19]]
* [[Swarming motility]]
 
{{Gram-negative bacterial diseases}}
 
{{DEFAULTSORT:Proteus Vulgaris}}
[[Category:Enterobacteria]]


==Transmission==
*''Proteus'' is usually transmitted to the human host by self-contamination (e.g. fecal material from gastrointestinal tract to genitourinary tract).


==References==
==References==
{{reflist|2}}
{{reflist|2}}
[[Category:Enterobacteria]]
[[Category:Gram negative bacteria]]
{{SIB}}

Latest revision as of 21:31, 28 January 2016

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Proteus
Scientific classification
Domain: Bacteria
Phylum: Proteobacteria
Class: Gamma Proteobacteria
Order: Enterobacteriales
Family: Enterobacteriaceae
Genus: Proteus
Hauser 1885
Species

P. mirabilis
P. morganii
Proteus penneri (P. penneri)
P. rettgeri
P. vulgaris
etc.

This page is about microbiologic aspects of the organism(s).  For clinical aspects of the disease, see Proteus infection.

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Proteus is a urease-producing, motile, nitrite-reducing, hydrogen sulfide-producing, catalase-positive, facultatively anaerobic, Gram-negative bacillus. It can be found in soil, water, and fecal matter. It inhabits the intestinal tracts of humans and animals, and is considered an opportunistic pathogen of humans. Transmission to the human host (usually urinary tract) typically occurs via self-contamination.

Taxonomy

Kingdom: Bacteria; Phylum: Proteobacteria; Class: Gamma proteobacteria; Order: Enterobacteriales; Family: Enterobacteria; Genus: Proteus; Species: Proteus mirabilis

Genome

  • Proteus contains more than 3,658 coding sequences with 7 rRNA loci.[1]
  • Total genome length is 4.063 Mb (28.8% GC content).[1]
  • Proteus contains a single plasmid that contains 26,298 nucleotides.[1]

Microbiological Characteristics

  • Proteus is a urease-producing, motile, nitrite-reducing, hydrogen sulfide-producing, catalase-positive, facultatively anaerobic, Gram-negative bacillus.
  • It grows optimally at 40 °C (104 °F).
  • It produces hydrogen sulfide gas, and forms clear films on growth media. It is motile, possessing peritrichous flagella, and is known for its swarming ability. It is commonly found in the intestinal tracts of humans. P. mirabilis is not pathogenic in guinea pigs or chickens.
  • Characteristically, Proteus can inhibit the growth of other strains in culture media, resulting in a macroscopically visible line (Dienes line) of reduced bacterial growth where two swarming strains intersect.
  • The following table summarizes the microbiological characteristics of Proteus:
Test Result
Indole Negative
Nitrate reductase Positive (no formation of gas bubbles)
Methyl red Positive
Voges-Proskauer Negative (may be positive)
Catalase Positive
Cytochrome oxidase Negative
Phenylalanine deaminase Positive
Tryptophan Negative
Urea (Harnstoff test) Positive
Casein Negative
Starch Negative
Hydrogen sulfide Positive
Citrate agar Negative
Ornithine decarboxylase Positive
Lysine decarboxylase Negative
Glucose fermentation Positive
Amygdalin fermentation Positive
Mannitol fermentation Negative
Lactose fermentation Negative

Natural Reservoir

  • Proteus can be found in soil, water, and fecal matter.
  • It inhabits the intestinal tracts of humans and animals, and is considered an opportunistic pathogen of humans.

Transmission

  • Proteus is usually transmitted to the human host by self-contamination (e.g. fecal material from gastrointestinal tract to genitourinary tract).

References

  1. ↑ 1.0 1.1 1.2 Pearson MM, Sebaihia M, Churcher C, Quail MA, Seshasayee AS, Luscombe NM; et al. (2008). "Complete genome sequence of uropathogenic Proteus mirabilis, a master of both adherence and motility". J Bacteriol. 190 (11): 4027–37. doi:10.1128/JB.01981-07. PMC 2395036. PMID 18375554.
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