Bacterial Pathogens and Disease I - Exotoxins Flashcards

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1
Q

What is a pathogen

A

A microorganism capable of causing disease.

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2
Q

What is meant by Pathogenicity

A

The ability of an infectious agent to cause disease

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3
Q

What is meant by Virulence

A

The quantitative ability of an agent to cause disease

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4
Q

What is meant by Toxigenicity

A

The ability of a microorganism to produce a toxin that contributes to the development of disease

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4
Q

Name the 4 virulence mechanisms

A
  • Adherence factors
  • Biofilms
  • Invasion of host cells and tissues
  • Toxins- Endotoxins and exotoxins
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5
Q

What are exotoxins

A
  • Heterogeneous group of proteins produced and secreted by living bacterial cells.
  • Produced by both gram-negative and gram-positive bacteria.
  • Cause disease symptoms in host during disease.
  • Act via a variety of diverse mechanisms.
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6
Q

why do pathogens have exotoxins

A
  • Evade immune response
  • Enable biofilm formation
  • Enable attachment to host cells.
  • Escape from phagosomes
  • All allowing for colonisation, niche establishment and carriage - Evolutionary advantage.
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7
Q

How do exotoxins help with Staphylococcus aureus

A

Haemolytic toxins:

  • cause cells to lyse by forming pores
  • Important cause of features of S. aureus disease.
  • α,β,𝛾, toxins ,Panton Valentine Leukocidin (PVL), LukAB, LukED, LukMF

Phenol soluble modulins PSM:

  • Aggregate the lipid bilayer of host cells - lysis
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8
Q

Describe the genetic expression for exotoxins

A

Can be encoded by chromosomal genes Shiga toxin in Shigella dysenteriae, TcdA & TcdB in C. difficile

Many toxins coded by extrachromosomal genes:

  • Plasmids – Bacillus anthracis toxin, tetanus toxin
  • Lysogenic bacteriophage – e.g. streptococcal pyrogenic exotoxins in Scarlet Fever, Diphtheria toxin.
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9
Q

How are exotoxins classified

A
  • Membrane Acting Toxins – Type I
  • Membrane Damaging Toxins – Type II
  • Intracellular Toxins – Type III

This classification has its problems –
Many toxins may have more than one type activity.
As mechanisms better understood this classification tends to break down.

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10
Q

How does Membrane Acting toxins – Type I work

A
  • Act from without the cell
  • Interfere with host cell signaling by inappropriate activation of host cell receptors
  • Target receptors include:
  • Guanylyl cyclase increases intracellular cGMP
  • Adenyl cyclase increases intracellular cAMP
  • Rho proteins
  • Ras proteins
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11
Q

How does Membrane Acting toxins – Type II work

A

Cause damage to the host cell membrane:

  • Insert channels into the host cell membrane.
    β sheet toxins e.g. S.aureus α – toxin, 𝛾 toxin, PVL
    α helix toxins – e.g. diphtheria toxin
  • Enzymatical damage e.g. S. aureus β- haemolysin, PSM

OR

  • Receptor mediated
  • Receptor independent
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12
Q

How does Membrane Acting toxins – Type III work

A

Active within the cell – must gain access to the cell

Usually 2 components – AB Toxins:

  • Receptor binding and translocation function – B
  • Toxigenic (enzymatic) – A
  • May be single or multiple B units e.g. Cholera toxin AB5
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13
Q

What enzymatic component A can we have in AB toxins

A
  • ADP – ribosyl transferases - e.g. Exotoxin A of Pseudomonas aeruginosa, pertussis toxin.
  • Glucosyltransferases – e.g. TcdA and TcdB of Clostridium difficile
  • Deamidase – e.g. dermonecrotic toxin of Bordetella pertussis.
  • Protease – e.g. Clostridial neurotoxins: botulism & tetanus
  • Adenylcyclase - e.g. EF (Edema factor) toxin of Bacillus anthracis
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14
Q

Describe how the super antigen mechanism work to induce a response

A

Non specific bridging of the MHC Class II and T- cell receptor leading to cytokine production:

  • E.g. Staphylococcal Exfoliative Toxin A, Toxic Shock Syndrome Toxin 1 (TSST1)

Via activation of the different inflammasome leading to release IL1 β and IL18 e.g. S. aureus toxin A, PVL.

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15
Q

What are toxoids

A
  • Toxins can be inactivated using formaldehyde or glutaraldehyde → toxoids
  • Toxoids are inactive proteins but still highly immunogenic – form the basis for vaccines.

Tetanus Vaccine
Diphtheria
Pertussis (acellular).*

16
Q

What is an alternative treatment for toxins apart from vaccines

A

Treatment of toxin mediated disease can be affected by administering preformed antibodies to the toxin:

  • Diphtheria antitoxin – horse antibodies.
  • Tetanus – pooled human immunoglobulin. Specific or normal.
  • Botulism – horse antibodies
17
Q

Describe the epidemiology of Clostridium difficile

A
  • Common hospital acquired infection worldwide.
  • Spread by ingestion of spores – remain dormant in environment.
  • Coloniser of the human gut up to 5% in adults.
  • Risk factors – antibiotic use, age, antacids & prolonged hospital stay.
17
Q

Describe the microbiology of Clostridium difficile

A
  • gram-positive bacillus.
  • anaerobic.
  • spore-forming.
  • toxin-producing.
  • can be carried asymptomatically in the gut.
  • 3 toxins.
18
Q

What is the effect of treating Clostridium difficile with antibiotics

A
  • Thought to act by disrupting the microbial ecosystem within the gut.
  • Antibiotics provide a competitive advantage to spore forming anaerobes over non spore forming anaerobes.
  • Allows C. difficile colonisation and growth.
  • All antibiotics have potential for causing disease.
19
Q

What are the toxins released by C. difficile

A
  • Cytotoxin A - TcdA coded by tcdA gene
  • CytotoxinB - TcdB coded by tcdB gene
  • Binary Toxin - C.diff transferase (CDT) - minor role in disease
  • Ted A and B - Type III AB toxins - The A component are glycosylating enzymes
20
Q

Describe the pathways which the toxins cause an effect

A
  • Toxins bind to specific host cell receptors
  • Toxin internalisation
  • Endosome acidification
  • Pore formation in the endosome
  • GTD release from the endosome to the host cell cytoplasm
  • Rho GTPases inactivation by glucosylation
  • Downstream effects within the host cell
21
Q

What are the cytopathic and cytotoxic effects of Clostridium difficile disease

A
  • Patchy necrosis with neutrophil infiltration
  • Epithelial ulcers
  • Pseudomembranes – leucocytes, fibrin, mucous, cell debris.
22
Q

how can we diagnose C. difficile

A

Raised white cell count in blood.

Detection of organisms and toxins in stool - 2 phase test:

  • Glutamate dehydrogenase – detects if C. difficile organism present.
  • Toxin enzyme linked immunosorbent assay (ELISA) for TcdA and TcdB toxins.

Detection of tcdA and tcdb genes – PCR

Colonoscopy – pseudomembranous colitis

23
Q

How can we treat C.dificle

A
  • Treatment dependent on severity and presence of surgical complications
  • Ideally removal of offending antibiotic – not always possible
  • Antibiotics fidaxomicin or metronidazole or vancomycin
  • Surgery – partial, total colectomy
  • Recurrent – faecal transplant.
24
Q

What is Verocytotoxin Escherichia coli (VTEC) disease

A

VTEC, or Shiga-toxin (Stx) producing E. coli (STEC) can cause disease mild to life threatening disease.

Stx carried by some E. coli – most commonly O157:H7:

  • Identified usually by growth on sorbitol MacConkey agar (SMac) – does not ferment sorbitol and hence is clear.
  • Other less common types not identified using SMac.
25
Q

What is the epidemiology of VTEC

A

E. coli O157:H7 naturally colonizes the gastrointestinal tracts of cattle who are generally asymptomatic.

Transmission :

  • Predominantly via consumption of contaminated food and water
  • Person to person, particularly in child day-care facilities, and from
  • Animal to person. E.g. in petting zoos, dairy farms, or camp grounds.

Very low infectious dose

26
Q

Describe the toxin produced by VTEC

A
  • Toxin – Shiga like toxin (SLT) = shigatoxin (Stx) = verocytotoxin (VTEC)
  • Stx, Stx1, Stx1a, 1c, 1d Stx2a, 2c, 2d – variations in a.a. sequence
  • Gene carried on lysogenic virus
  • Type III exotoxin – AB5
  • Enzymatic component A = N-Glycosidase
  • Bound to 5 B subunits
27
Q

Describe the mechanism of the toxin activity

A
  • Bind to receptor globotriaosylceramide Gb3 or globotetraosylceramide (Gb4) on host cell membrane
  • Bound toxin internalised by receptor mediated endocytosis.
  • Carried by retrograde trafficking via the Golgi apparatus to the endoplasmic reticulum.
  • The A subunit is cleaved off by membrane bound proteases
  • Once in the cytoplasm A1 and A2 disassociate
  • A1 binds to 28S RNA subunit – blocks protein synthesis.
28
Q

Describe the pathogenesis of STEC

A
  • STEC closely adheres to the epithelial cells of the gut mucosa.
  • The route by which Stx is transported from the intestine to the kidney and other tissues is debated, possibly polymorphonuclear neutrophils (PMNs)
  • Bind to glomerular endothelial cells of kidney, cardiovascular and central nervous system.
  • Very high levels of Gb3 in kidney so kidneys most affected.
  • Thought that Stx favours inflammation resulting in microvascular thrombosis and inhibition of fibrinolysis.
29
Q

What is STEC disease

A

Can be severe and life threatening

Children < 5 years greatest risk

Abdominal cramps, watery or bloody diarrhoea – may not be present

Haemolytic uraemic syndrome:

  • Anaemia
  • Renal Failure
  • Thrombocytopaenia

Less common are neurological symptoms:

  • lethargy,
  • severe headache,
  • convulsions,
  • encephalopathy
30
Q

How do we diagnose and treat STEC

A

Diagnosis:

  • Haematological and biochemical evidence
  • Stool culture - Growth on SMac
  • PCR for Stx genes

Treatment:

  • Supportive including renal dialysis and blood product transfusion
  • Antibiotics have little to no role