Klebsiella

Clasificación

Características Generales

Características generales

• Bacilos gramnegativos
• Anaerobios facultativos
• Inmóvil
• Encapsulado (cápsula de polisacárido)
• Solos, en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum parejas o cadenas cortas
• Forma grandes colonias mucoides.
• Principales especies patógenas: Klebsiella pneumoniae Klebsiella Pneumoniae Gram-negative, non-motile, capsulated, gas-producing rods found widely in nature and associated with urinary and respiratory infections in humans. Aminoglycosides

Bioquímica

• Fermentadores de lactosa:
  • Fermentan la lactosa a ácido láctico
  • Colonias rosadas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum agar MacConkey
• Ureasa positiva: hidrólisis de la urea Urea A compound formed in the liver from ammonia produced by the deamination of amino acids. It is the principal end product of protein catabolism and constitutes about one half of the total urinary solids. Urea Cycle en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum amoníaco y dióxido de carbono
• Oxidasa negativa
• Pueden usar citrato y glucosa como únicas fuentes de carbono.
• Pueden utilizar amoníaco como única fuente de nitrógeno.

Hábitats/reservorio

• Agua/suelo
• Plantas, animales e insectos
• Flora normal de la nariz, la boca y el tracto gastrointestinal humanos.

Factores virulentos

• Cápsula de polisacárido:
  • Evade la fagocitosis
  • 77 serotipos de cápsulas diferentes
  • Los LOS Neisseria tipos K1 y K2 son los LOS Neisseria más virulentos.
• Fenotipo con hipermucoviscosidad:
  • Producción de red de exopolisacárido mucoviscoso
  • Asociado con abscesos hepáticos y otros abscesos tisulares destructivos
  • Prueba de las cuerdas: > hilo viscoso de 5 mm cuando la colonia en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la placa de agar se estira usando un asa ASA Anterior Cord Syndrome bacteriológica
• Lipopolisacárido:
  • Cadena lateral de lipopolisacárido tipo O
  • Protege a las bacterias del daño de la membrana mediado por el complemento
• Sideróforos:
  • Quelantes de hierro
  • Mejoran la absorción de hierro, que es vital para el crecimiento de Klebsiella Klebsiella Klebsiella are encapsulated gram-negative, lactose-fermenting bacilli. They form pink colonies on MacConkey agar due to lactose fermentation. The main virulence factor is a polysaccharide capsule. Klebsiella pneumoniae is the most important pathogenic species. Klebsiella
• Pili Pili Filamentous or elongated proteinaceous structures which extend from the cell surface in gram-negative bacteria that contain certain types of conjugative plasmid. These pili are the organs associated with genetic transfer and have essential roles in conjugation. Normally, only one or a few pili occur on a given donor cell. This preferred use of ‘pili’ refers to the sexual appendage, to be distinguished from bacterial fimbriae, also known as common pili, which are usually concerned with adhesion. Salmonella (fimbrias):
  • Median la adherencia a las superficies epiteliales y mucosas.
  • Forman biopelículas resistentes al AL Amyloidosis tratamiento

Relevancia Clínica

Epidemiología y transmisión

• Tasa de portadores:
  • 5%–38% colonización intestinal
  • 1%–6% nasofaríngeo
  • Tasas de portadores más altas:
    • Individuos con trastorno por consumo de alcohol (nasofaríngeo)
    • Etnia china (intestinal)
    • Pacientes hospitalizados
• Transmisión:
  • La infección nosocomial más común
  • Adquirido en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la comunidad es el menos frecuente
  • Persona a persona
  • Asociado con aspiración (neumonía)
  • Contaminación del medio ambiente (raro)
• Factores de riesgo:
  • Trastorno por consumo de alcohol (neumonía adquirida en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la comunidad)
  • Deterioro de las defensas del huésped:
    • Hospitalización, especialmente si está cateterizado o intubado
    • Diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus
    • Enfermedad pulmonar obstructiva crónica grave

Manifestaciones infecciosas

Neumonía:

• 7,6% de las neumonías adquiridas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el hospital (pacientes intubados y no intubados)
• En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria casos adquiridos en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la comunidad, predilección por los LOS Neisseria segmentos posteriores del lóbulo superior derecho
• Esputo “jalea color grosellas”
• Fiebre, tos TOS Thoracic outlet syndrome (TOS) is a broad term used for a spectrum of syndromes related to the general region of the thoracic outlet, which involves the compression or irritation of elements of the brachial plexus, subclavian artery, or subclavian vein. Thoracic Outlet Syndrome, disnea, dolor Dolor Inflammation torácico pleurítico
• Complicaciones:
  • Absceso pulmonar (puede simular tuberculosis Tuberculosis Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis complex bacteria. The bacteria usually attack the lungs but can also damage other parts of the body. Approximately 30% of people around the world are infected with this pathogen, with the majority harboring a latent infection. Tuberculosis spreads through the air when a person with active pulmonary infection coughs or sneezes. Tuberculosis en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la radiografía de tórax)
  • Empiema

Infecciones del tracto urinario:

• Tercera causa principal de infecciones urinarias
• Puede causar infecciones del traco urinario inferior (cistitis) y superior (pielonefritis)
• Puede estar asociado con cálculos renales de fosfato de amonio y magnesio (estruvita)
• En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum pacientes hospitalizados con sondas vesicales

Bacteriemia relacionada con el catéter:

• Asociado a catéteres venosos centrales
• Causa relativamente infrecuente (aproximadamente 5%)

Infecciones menos frecuentes:

• Intraabdominal:
  • Absceso hepático
  • Absceso de bazo
  • Peritonitis Peritonitis Inflammation of the peritoneum lining the abdominal cavity as the result of infectious, autoimmune, or chemical processes. Primary peritonitis is due to infection of the peritoneal cavity via hematogenous or lymphatic spread and without intra-abdominal source. Secondary peritonitis arises from the abdominal cavity itself through rupture or abscess of intra-abdominal organs. Penetrating Abdominal Injury bacteriana espontánea
• Meningitis Meningitis Meningitis is inflammation of the meninges, the protective membranes of the brain, and spinal cord. The causes of meningitis are varied, with the most common being bacterial or viral infection. The classic presentation of meningitis is a triad of fever, altered mental status, and nuchal rigidity. Meningitis: generalmente asociada con procedimientos neuroquirúrgicos
• Endocarditis Endocarditis Endocarditis is an inflammatory disease involving the inner lining (endometrium) of the heart, most commonly affecting the cardiac valves. Both infectious and noninfectious etiologies lead to vegetations on the valve leaflets. Patients may present with nonspecific symptoms such as fever and fatigue. Endocarditis
• Endoftalmitis
• Infecciones de piel y tejidos blandos

Mnemotécnia

Para ayudar a recordar las manifestaciones clínicas de Klebsiella Klebsiella Klebsiella are encapsulated gram-negative, lactose-fermenting bacilli. They form pink colonies on MacConkey agar due to lactose fermentation. The main virulence factor is a polysaccharide capsule. Klebsiella pneumoniae is the most important pathogenic species. Klebsiella , recuerde “las 5 As de Klebsiell A”:

• Neumonía por aspiración
• Trastorno por consumo de alcohol
• Abscesos en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum pulmones e hígado
• Di-A-betes
• Esputo “jalea de grosella”

Resistencia antibiótica

• Algunas cepas producen betalactamasas de espectro extendido.
• Resistencia a la mayoría de los LOS Neisseria antibióticos betalactámicos: cefalosporinas, penicilinas, monobactámicos, carbapenémicos
• Algunas cepas también tienen resistencia cruzada a otros antibióticos (resistencia a múltiples medicamentos).
• Factor de riesgo mayor: exposición previa a antibióticos
• Mediada por plásmidos que codifican betalactamasas y otras enzimas modificadoras
• Plásmidos intercambiados a través de fimbrias

Identificación

• Tinción de Gram:
  • Esputo: sensibilidad alrededor del 50%
• Cultivos:
  • Sangre
  • Orina
  • Fluidos corporales
  • Aspirados del absceso