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Which of the following production by the bacterium AIDS in the virulence of the causal organism in this patient?
A 23-year-old woman comes to the physician because of a 1-day history of chills, nausea, and vomiting. She also has a 4-day history of flank pain, urinary frequency and urgency, and pain with urination. Her temperature is 38.9C (102°F), a pulse is 125/min, and blood pressure is 96/60 mm Hg. Physical examination shows right costovertebral angle tenderness. Urinalysis shows 25 WBC/HPF. A urine sample grows pink colonies on lactose-MacConkey agar. produces a characteristic green sheen on eosin-methylene blue agar, and is indole positive.



A. Adhesins
B. Antihemolytic factors
C. Pyrogenic exotoxin
D. The teichoic acid in the cell wall
E. Thick peptidoglycan layer

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NBME 13 section 1 prt 2 of 2
Asked by Jeremiah, Last updated: Jul 06, 2020

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John Smith

John Smith

Answered Sep 09, 2016

Adhesins-any organism that produces high levels of acid from lactose fermentation can produce a green sheen on emb agar. commonly, e. coli produces a green sheen, but klebsiella pneumonia and sometimes klebsiells oxytoca can as well. although, the colonial morphology of the klebsiella spp. would be very much different than e. coli. best to think of emb differentiating between lactose fermenters and non-lactose fermenterswith the green sheen characteristic being a bonus for some organisms.adhesins are cell-surface components or appendages of bacteria that facilitate bacterial adhesion or adherence to other cells or to inanimate surfaces. adhesins are a type of virulence factor.uropathogenic e. coli (upec) is responsible for approximately 90% of urinary tract infections (uti) seen in individuals with ordinary anatomy. in ascending infections, fecal bacteria colonize the urethra and spread up the urinary tract to the bladder as well as to the kidneys (causing pyelonephritis), or the prostate in males. because women have a shorter urethra than men, they are 14 times more likely to suffer from an ascending uti. uropathogenic e. coli use p fimbriae (pyelonephritis-associated pili) to bind urinary tract endothelial cells and colonize the bladder. these adhesins specifically bind d-galactose-d-galactose moieties on the p blood-group antigen of erythrocytes and uroepithelial cells. approximately 1% of the human population lacks this receptor[citation needed], and its presence or absence dictates an individuals susceptibility or non-susceptibility, respectively, to e. coli urinary tract infections. uropathogenic e. coli produce alpha- and beta-hemolysins, which cause lysis of urinary tract cells.another virulence factor commonly present in upec is the dr family of adhesins, which are particularly associated with cystitis and pregnancy-associated pyelonephritis. the dr adhesins bind dr blood group antigen (dra) which is present on decay accelerating factor (daf) on erythrocytes and other cell types. there, the dr adhesins induce the development of long cellular extensions that wrap around the bacteria, accompanied by the activation of several signal transduction cascades, including activation of pi-3 kinase
 

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