Pathogenic bacteria Information & Pathogenic bacteria Links at HealthHaven.com

Pathogenic bacteria are bacteria that cause infectious diseases. This article deals with human pathogenic bacteria.

Although the vast majority of bacteria are harmless or beneficial, quite a few bacteria are pathogenic. One of the bacterial diseases with highest disease burden is tuberculosis, caused by the bacterium Mycobacterium tuberculosis, which kills about 2 million people a year, mostly in sub-Saharan Africa. Pathogenic bacteria contribute to other globally important diseases, such as pneumonia, which can be caused by bacteria such as 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.

[edit] History

Koch's postulates, proposed by Robert Koch in 1890, are criteria designed to establish a causal relationship between a causative microbe and a disease. A pathogenic cause for a known medical disease may only be discovered many years after, as was the case with Helicobacter pylori and peptic ulcer disease.

[edit] Diseases

Each pathogenic species has a characteristic spectrum of interactions with its human hosts.

[edit] Conditionally pathogenic

Some organisms, such as Staphylococcus or Streptococcus, can cause skin infections, pneumonia, meningitis and even overwhelming sepsis, a systemic inflammatory response producing shock, massive vasodilation and death.^[1]

Yet these organisms are also part of the normal human flora and usually exist on the skin or in the nose without causing disease.

[edit] Intracellular

Other organisms invariably cause disease in humans, such as the Rickettsia, which are obligate intracellular parasites able to grow and reproduce only within the cells of other organisms. One species of Rickettsia causes typhus, while another causes Rocky Mountain spotted fever.

Chlamydia, another phylum of obligate intracellular parasites, contains species that can cause pneumonia, or urinary tract infection and may be involved in coronary heart disease.^[2]

Mycobacterium and Brucella can exist intracellularly, though they are facultative (not obligate intracellular parasites.)

[edit] Opportunistic

Some species of bacteria, such as Pseudomonas aeruginosa, Burkholderia cenocepacia, and Mycobacterium avium, are opportunistic pathogens and cause disease mainly in people suffering from immunosuppression or cystic fibrosis.^[3]^[4]

[edit] 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, and so exhibit selective toxicity.^[5] 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.^[6] 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 contamination and 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. Most bacteria in food are killed by cooking to temperatures above 73 °C (163°F).

[edit] Basic laboratory characteristics

The following genera contain the most important human pathogenic bacteria species: ^[7]

Clinically most important human pathogenic bacteria genera^[8] and species
Genus	Important species	Gram staining	Shape	Capsulation	Bonding tendency	Motility	Respiration	Growth medium	Intra/Extracellular
Bordetella	Bordetella pertussis	Gram-negative	Small coccobacilli	Encapsulated	singly or in pairs		aerobic	Regan-Lowe agar	extracellular
Borrelia	Borrelia burgdorferi	Gram-negative, but stains poorly			Long, slender, flexible, spiral- or corkscrew-shaped rods	highly motile	(difficult to culture)		extracellular
Brucella	Brucella abortus Brucella canis Brucella melitensis Brucella suis	Gram-negative	Small coccobacilli	Unencapsulated	singly or in pairs		aerobic	Blood agar	intracellular
Campylobacter	Campylobacter jejuni	Gram-negative	Curved, spiral, or S-shaped with single, polar flagellum			characteristic darting motion	microaerophilic	Blood agar inhibiting other fecal flora	extracellular
Chlamydia	Chlamydia pneumoniae Chlamydia psittaci Chlamydia trachomatis	(not Gram-stained)	Small, round, ovoid				motile	Facultative or strictly aerobic	Obligate intracellular
Clostridium	Clostridium botulinum Clostridium difficile Clostridium perfringens Clostridium tetani	Gram-positive	Large, blunt-ended rods			mostly motile	Obligate anaerobic	Anaerobic blood agar	extracellular
Corynebacterium	Corynebacterium diphtheriae	Gram-positive (unevenly)	Small, slender, pleomorphic rods	unencapsulated	clumps looking like Chinese characters or a picket fence	nonmotile	Mostly facultative anaerobic	Aerobically on Tinsdale agar	extracellular
Enterococcus	Enterococcus faecalis Enterococcus faecum	Gram-positive	Round to ovoid		pairs or chains		6.5% NaCl, bile-esculin agar		extracellular
Escherichia	Escherichia coli	Gram-negative	Short rods				Facultative anaerobic	MacConkey agar	extracellular
Francisella	Francisella tularensis	Gram-negative	Small, pleomorphic coccobacillus				strictly aerobic	(rarely cultured)	Facultative intracellular
Haemophilus	Haemophilus influenzae	Gram-negative	Ranging from small coccobacillus to long, slender filaments					Chocolate agar with hemin and NAD⁺	extracellular
Helicobacter	Helicobacter pylori	Gram-negative	Curved or spiral rods pultiple polar flagella			rapid, corkscrew motility		Medium containing antibiotics against other fecal flora	extracellular
Legionella	Legionella pneumophila	Gram-negative, but stains poorly	Slender rod in nature, cocobacillary in laboratory. monotrichious flagella	unencapsulated		motile		Specialized medium	facultative intracellular
Leptospira	Leptospira interrogans	Gram-negative, but stains poorly	Long, very slender, flexible, spiral- or corkscrew-shaped rods			highly motile		Specialized medium	extracellular
Listeria	Listeria monocytogenes	Gram-positive, darkly	Slender, short rods		diplobacilli or short chains	Distinct tumbling motility in liquid medium		enriched medium	intracellular
Mycobacterium	Mycobacterium leprae Mycobacterium tuberculosis	(none)	Long, slender rods			nonmotile	aerobic	M. tuberculosis: Lowenstein-Jensen agar M. leprae: (none)	extracellular
Mycoplasma	Mycoplasma pneumoniae	(none)	Plastic, pleomorphic		singly or in pairs			(rarely cultured)	extracellular
Neisseria	Neisseria gonorrhoeae Neisseria meningitidis	Gram-negative	Kidney bean-shaped		diplococci		aerobic	Thayer-Martin agar	Gonococcus: facultative intracellular N. meningitidis: extracellular
Pseudomonas	Pseudomonas aeruginosa	Gram-negative	rods	encapsulated		motile	Obligate aerobic	MacConkey agar	extracellular
Rickettsia	Rickettsia rickettsii	Gram-negative, but stains poorly	Small, rod-like coccobacillary					(rarely cultured)	Obligate intracellular
Salmonella	Salmonella typhi Salmonella typhimurium	Gram-negative					Facultative anaerobic	MacConkey agar	Facultative intracellular
Shigella	Shigella sonnei	Gram-negative	rods				Facultative anaerobic	Hektoen agar	extracellular
Staphylococcus	Staphylococcus aureus Staphylococcus epidermidis Staphylococcus saprophyticus	Gram-positive, darkly	Round cocci		in bunches like grapes		Facultative anaerobic	enriched medium (broth and/or blood)	extracellular
Streptococcus	Streptococcus agalactiae Streptococcus pneumoniae Streptococcus pyogenes	Gram-positive	ovoid to spherical		pairs or chains	nonmotile	Facultative anaerobic	blood agar	extracellular
Treponema	Treponema pallidum	Gram-negative, but stains poorly	Long, slender, flexible, spiral- or corkscrew-shaped rods			highly motile		none	extracellular
Vibrio	Vibrio cholerae	Gram-negative	Short, curved, rod-shaped with single polar flagellum			rapidly motile	Facultative anaerobic	blood- or MacConkey agar. Stimulated by NaCl	extracellular
Yersinia	Yersinia pestis	Gram-negative, stains bipolarly	Small rods	encapsulated		nonmotile	nbvk	MacConkey or CIN agar	extracellular

[edit] Clinical characteristics

This is a rather clinical description of the species presented in the previous section, containing the main examples of transmission, diseases, treatment, prevention and laboratory diagnosis, which all can differ substantially among the species of the same genus.

Species of human pathogenic bacteria ^[8]
Species	Transmission	Diseases	Treatment	Prevention	laboratory diagnosis
Bacillus anthracis	Contact with sheep, goats and horses Inhalation or skin penetration through abrasions of spor-contaminated dust	Cutaneous anthrax Pulmonary anthrax Gastrointestinal anthrax	In early infection: Penicillin Doxycycline Ciprofloxacin	Anthrax vaccine autoclaving of instruments	Large, grayish, nonhemolytic colonies with irregular borders on blood agar Direct immunofluorescence
Bordetella pertussis	Contact with respiratory droplets expelled by infected human hosts.	Whooping cough Complications: Secondary bacterial pneumonia	Macrolide antibiotics Azithromycin Erythromycin Clarithromycin	Pertussis vaccine, DPT vaccine	Direct immunofluorescence PCR amplification
Borrelia burgdorferi	Ixodes ticks reservoir in deer, mice and other rodents	Lyme disease	Early stages: cephalosporins amoxicillin doxycycline If arthritic symptoms have appeared: Longer courses of antibiotics	Lyme vaccine wearing clothing that limits skin exposure to ticks insect repellent	Microscopy using Giemsa or Wright stain PCR serology (low precision rate)
Brucella abortus Brucella canis Brucella melitensis Brucella suis	Direct contact with infected animal Oral, by ingestion of unpasteurized milk or milk products	Brucellosis	Combination therapy of: doxycycline streptomycin or gentamicin	-	Culture (difficult and time consuming) Agglutination serology
Campylobacter jejuni	Fecal/oral from animals (mammals and fowl) Contaminated meat (especially poultry) Contaminated water	Acute enteritis	Symptomatically by fluid and electrolyte replacement Ciprofloxacin in severe cases	No available vaccine Good hygiene Avoiding contaminated water Pasteurizing milk and milk products Cooking meat (especially poultry)	Finding campylobacter in feces
Chlamydia pneumoniae	Respiratory droplets	Community-acquired respiratory infection	Doxycycline Erythromycin	None	None for routine use
Chlamydia psittaci	Inhalation of dust with secretions or feces from birds (e.g. parrots)	Psittacosis	Tetracycline Doxycycline Erythromycin (less efficient)	-	Rise in antibody titer Complement fixation indirect immunofluorescence
Chlamydia trachomatis	Sexual (NGU, LGV) Direct or contaminated surfaces and flies (trachoma) Passage through birth canal (ICN)	Nongonococcal urethritis (NGU) Trachoma Inclusion conjunctivitis of the newborn (ICN) Lymphogranuloma venereum (LGV)	Azithromycin Erythromycin Tetracyclines Doxycycline	No vaccine Erythromycin or silver nitrate in newborn's eyes Safe sex	Cellular cytoplasmic inclusions by immunofluorescence DNA hybridization ELISA for lipopolysaccharides
Clostridium botulinum	Spores from soil and aquatic sediments contaminating vegetables, meat and fish	Botulism	Antitoxin (horse antiserum)	Proper food preservation techniques	Mouse inoculation detects toxin from food, intestinal contents or serum Culture in standard aerobic culture
Clostridium difficile	Spores both indoors and outdoors Human flora, overgrowing when other flora is depleted	Pseudomembranous colitis	Discontinuing predisposing antibiotic Fluid and electrolyte replacement Vancomycin or metronidazole if severe	None	ELISA for Toxin ELISA for toxin A or B Endoscopy for pseudomembrane
Clostridium perfringens	Spores in soil Human flora in vagina and GI tract	Gas gangrene Acute food poisoning Anaerobic cellulitis	Gas gangrene: Debridement or amputation Hyperbaric medicine High doses of penicillin G or doxycycline Food poisoning: Self-limiting; Supportive care is sufficient	Appropriate food handling	Microscopically Blood agar culture, forming double-zone β-hemolysis Sugar fermentation Organic acid production
Clostridium tetani	Spores in soil infecting puncture wounds, severe burns or surgery	Tetanus	Tetanus immune globulin Horse antitoxin, alternatively Sedatives Muscle relaxants Mechanical ventilation	DPT vaccine	(difficult)
Corynebacterium diphtheriae	Respiratory droplets Part of human flora	Diphtheria	Horse serum antitoxin Erythromycin Penicillin	DPT vaccine	(no rapid) Culture on Tinsdale agar, followed by immunologic precipitin reaction
Enterococcus faecalis and Enterococcus faecum	Part of human flora, opportunistic or entering through GI tract or urinary system wounds	Nosocomial infections	Penicillin and an aminoglycoside Vancomycin Quinupristin and dalfopristin	No vaccine Hand washing and other nosocomial prevention	Culture in 6.5% NaCl Can hydrolyze esculin in presence of bile
Escherichia coli (generally)	Part of gut flora, spreading extraintestinally or proliferating in the GI tract	Urinary tract infections (UTI) Diarrhea Meningitis in infants	UTI: (resistance-tests are required first) Co-trimoxazole Fluoroquinolone, e.g. ciprofloxacin Meningitis: Cephalosporin (e.g. cefotaxime) and gentamicin combination Diarrhea: Antibiotics above shorten duration Electrolyte and fluid replacement	(no vaccine or preventive drug) Food and water preparation Cooking ground beef and pasteurizing milk against O157:H7 Hand washing and disinfection	Culture on MacConkey agar and study carbohydrate fermentation patterns: Lactose fermentation (most E. coli strains) Gas production in glucose fermentation Mannitol fermentation
Enterotoxigenic Escherichia coli (ETEC)	Fecal-oral through food and water Direct physical contact	Traveller's diarrhea
Enteropathogenic E. coli	Vertical, in utero or at birth	Diarrhea in infants
E. coli O157:H7	Reservoir in cattle	Hemorrhagic colitis Hemolytic-uremic syndrome
Francisella tularensis	vector-borne by anthropods Infected wild or domestic animals, birds or house pets	Tularemia	Streptomycin Gentamicin	Avoiding insect vectors Precautions when handling wild animals or animal products	(rarely cultured) Serology
Haemophilus influenzae	Droplet contact Human flora of e.g. upper respiratory tract	Bacterial meningitis Upper respiratory tract infections Pneumonia, bronchitis	Meningitis: (resistance-tests are required first) Third generation cephalosporin, e.g. cefotaxime or ceftriaxone Ampicillin and sulbactam combination	Hib vaccine to infants Rifampin prophylactically	Culture on chocolate agar with hemin (factor X) and NAD⁺ (factor V) Quellung reaction Immunofluorescence staining of capsule Detection of capsular antigen in CSF or other body fluids
Helicobacter pylori	Colonizing stomach Unclear person-to-person transmission	Peptic ulcer Risk factor for gastric carcinoma and gastric B-cell lymphoma	Tetracycline, metronidazole and bismuth salt combination	(No vaccine or preventive drug)	Microscopically Corkscrew movement Urease-positivity by radioactively labeled urea Serology by ELISA
Legionella pneumophila	Droplet contact, from e.g. cooling towers, humidifiers, air conditioners and water distribution systems	Legionnaire's Disease Pontiac fever	Macrolides, e.g. erythromycin or azithromycin Fluoroquinolones	(no vaccine or preventive drug) Heating water	Culture from respiratory secretions on buffered charcoal yeast extract enriched with L-cysteine, iron and α-ketoglutarate Serology, including direct immunofluorescence and radioimmunoassay for antigen in urine Hybridization to ribosomal RNA using DNA probe
Leptospira interrogans	Food and water contaminated by e.g. urine from wild or domestic animals. Leptospira survives for weeks in stagnant water.	Leptospirosis	Penicillin G Tetracycline, e.g. doxycycline	(no vaccine) Doxycycline Prevention of exposure Rodent control	Dark-field microscopy on fresh blood smear (but doesn't stain well) Serologic agglutionation tests
Listeria monocytogenes	Dairy products, ground meats, poultry Vertical to newborn or fetus	Listeriosis	Ampicillin Co-trimoxazole	(no vaccine) Proper food preparation and handling	Isolation from e.g. blood and CSF Beta-hemolysis and catalase production on blood agar Microschopy for morphology and motility
Mycobacterium leprae	Prolonged human-human contact, e.g. through exudates from skin lesions to abrasion of other person	Leprosy (Hansen's disease)	Tuberculoid form: Dapsone and rifampin Lepromatous form: Clofazimine	BCG vaccine shows some effects	Tuberculoid form: Hard to isolate (diagnosis on clinical findings and histology of biopsies) Lepromatous form: Acid-fast staining from e.g. skin scrapings
Mycobacterium tuberculosis	Droplet contact	Tuberculosis	Isoniazid, ethambutol, streptomycin, and/or pyrazinamide combination	BCG vaccine Isoniazid	Ziehl-Neelsen stain showing acid-fast bacteria Hybridization probes for DNA, succeeded by PCR Culture on Lowenstein-Jensen agar
Mycoplasma pneumoniae	Human flora Droplet contact	Mycoplasma pneumonia	Doxycycline and erythromycin		(difficult to culture) Serologic tests, e.g. complement fixation test DNA probes on sputum specimens
Neisseria gonorrhoeae	Sexually transmitted vertical in birth	Gonorrhea Ophthalmia neonatorum Septic arthritis	Uncomplicated gonorrhea: Ceftriaxone Tetracycline, e.g. doxycycline if also chlamydia is suspected Spectinomycin for resistance or patient allergy to cephalosporin Ophthalmia neonatorum: Tetracycline or erythromycin into eyes	(No vaccine) Safe sex Tetracycline or erythromycin into eyes of newborn at risk	Gram-negative diplococci in neutrophils from urethral exudates Oxidase test on culture on Thayer-Martin agar under increased oxygen tension Fermentation of glucose but not maltose
Neisseria meningitidis	Respiratory droplets	Meningococcal disease including meningitis Waterhouse-Friderichsen syndrome	Penicillin G Cefotaxime Ceftriaxone	NmVac4-A/C/Y/W-135 vaccine Rifampin	Microscopy showing gram-negative diplococci, often with PMNs Culture on chocolate agar, giving positive oxidase test and fermentation of glucose and maltose in 5% CO₂ in air
Pseudomonas aeruginosa	Infects damaged tissues or people with reduced immunity.	Pseudomonas infection Localized to eye, ear, skin, urinary, respiratory or gastrointestinal tract or CNS, or systemic with bacteremia, secondary pneumonia bone and joint infections, endocarditis, skin, soft tissue or CNS infections.	Aminoglycoside and anti-pseudomonal β-lactam	(no vaccine) Topical silver sulfadiazine for burn wounds	Colourless colonies on MacConkey agar. Production of pyocyanine and fluorescein Positive oxidase test. No lactose fermentation.
Rickettsia rickettsii	Bite of infected wood or dog tick	Rocky mountain spotted fever	Doxycycline Chloramphenicol	(no preventive drug or approved vaccine) Vector control, such as clothing Prompt removal of attached ticks	Serology Immunofluorescence against Rickettsia antigens
Salmonella typhi	Human-human Fecal-oral through food or water	Typhoid fever type salmonellosis (dysentery, colitis)	Ceftriaxone Fluoroquinolones, e.g. ciprofloxacin	Ty21a and ViCPS vaccines Hygiene and food preparation	Isolation from blood, feces, bone marrow, urine or rose spots on skin Colorless, non-lactose fermenting colonies on MacConkey agar Serology for antibodies against O antigen
Salmonella typhimurium	Fecal-oral Food contaminated by fowl (e.g. eggs), pets and other animals	Salmonellosis with gastroenteritis and enterocolitis	Fluid and electrolyte replacement for severe diarrhea Antibiotics (in immunocompromised to prevent systemic spread)	(No vaccine or preventive drug) Proper sewage disposal Food preparation Good personal hygiene	Colourless colonies on MacConkey agar
Shigella sonnei	Fecal-oral Flies Contaminated food or water	Bacillary dysentery/Shigellosis	Ciprofloxacin or azithromycin	Protection of water and food supplies Vaccines are in trial stage^[9]	Culture on Hektoen agar or other media for intestinal pathogens
Staphylococcus aureus	Human flora on mucosae in e.g. anterior nares and vagina, entering through wound	Coagulase-positive staphylococcal infections: Localized skin infections Diffuse skin infection (Impetigo) Deep, localized infections Acute infective endocarditis Septicemia Necrotizing pneumonia Toxinoses Toxic shock syndrome Staphylococcal food poisoning	Incision and drainage of localized lesions Nafcillin and oxacillin Vancomycin for Methicillin-resistant (MRSA)	(no vaccine or preventive drug) Barrier precautions, washing hands and fomite disinfection in hospitals	Microscopy showing strongly positive Gram stained cells in grape-like clusters Positive Catalase test and coagulase test Culture on enriched media producing deep yellow, hemolytic colonies
Staphylococcus epidermidis	Human flora in skin and anterior nares	Infections of implanted prostheses, e.g. heart valves and catheters	Vancomycin	None	Microscopy showing strongly positive Gram stained cells in grape-like clusters Positive Catalase test but negative coagulase test Novobiocin-sensitivity (S. epidermidis) Novobiocin-resistance (S. saprophyticus) Culture on enriched media producing white, nonhemolytic colonies
Staphylococcus saprophyticus	Part of normal vaginal flora	Cystitis in women	Penicillin G	None
Streptococcus agalactiae	Human flora in vagina or urethral mucous membranes, rectum Vertical transmission by birth Sexual	Meningitis and septicemia in neonates Endometritis in postpartum women Opportunistic infections with septicemia and pneumonia	Penicillin G Ampicillin Aminoglycoside in case of lethal infection	None	Culture showing large colonies with β-hemolysis Negative catalase test Hydrolyzes sodium hippurate
Streptococcus pneumoniae	Respiratory droplets Often human flora in nasopharynx (spreading in immunocompromised)	Acute bacterial pneumonia & meningitis in adults Otitis media and sinusitis in children	Penicillin G Vancomycin for resistant strains	23-serotype vaccine for adults (PPV) Heptavalent conjugated vaccine for children (PCV)	Microscopy showing gram-positive, encapsulated lancet-shaped diplococci α-hemolysis on blood agar, bile-soluble, optochin-sensitive Positive Quellung reaction
Streptococcus pyogenes	Respiratory droplets Direct physical contact with impetigo lesions	Streptococcal pharyngitis Scarlet fever Rheumatic fever Impetigo and erysipelas Puerperal fever Necrotizing fasciitis	Penicillin G Macrolide, e.g. clarithromycin or azithromycin in penicillin allergy Drainage and debridement for Necrotizing fasciitis	No vaccine Rapid antibiotic treatment helps prevent rheumatic fever	Culture on sheep agar forming small, opalescent surrounded by large zone of β-hemolysis Serology for ASO Very bacitracin-sensitive
Treponema pallidum	Sexual	Syphillis Congenital syphilis	Penicillin G Erythromycin or tetracycline if penicillin allergy	No preventive drug or vaccine Safe sex Antibiotics to pregnant women at risk of transmitting congenital syphilis	Cannot be cultured or viewed in gram-stained smear Dark field microscopy Serology, including nontreponemal (VDRL, RPR) and treponemal tests (FTA-ABS, TPI, TPHA)
Vibrio cholerae	Contaminated water and food, especially raw seafood	Cholera	Fluid and electrolyte replacement e.g. doxycycline to shorten duration	Preventing fecal contamination of water supplies and food Adequate food preparation	Culture on blood or MacConkey agar, enhanced by TCBS Positive oxidase test
Yersinia pestis	Fleas from animals Ingestion of animal tissues Respiratory droplets	Plague: Bubonic plague Pneumonic plague	Streptomycin primarily Gentamicin Tetracyclin Supportive therapy for shock	Formalin-killed plague vaccine Minimize exposure to rodents and fleas	Gram-negative smear If pneumonic, culture from aspirate on MacConkey or blood agar

[edit] See also

[edit] References

^ Fish DN (February 2002). "Optimal antimicrobial therapy for sepsis". Am J Health Syst Pharm 59 (Suppl 1): S13–9. PMID 11885408. http://www.ajhp.org/cgi/pmidlookup?view=long&pmid=11885408.
^ Belland R, Ouellette S, Gieffers J, Byrne G (2004). "Chlamydia pneumoniae and atherosclerosis". Cell Microbiol 6 (2): 117–27. doi:10.1046/j.1462-5822.2003.00352.x. PMID 14706098.
^ Heise E (1982). "Diseases associated with immunosuppression". Environ Health Perspect 43: 9–19. doi:10.2307/3429162. PMID 7037390.
^ Saiman L (2004). "Microbiology of early CF lung disease". Paediatr Respir Rev 5 (Suppl A): S367–9. doi:10.1016/S1526-0542(04)90065-6. PMID 14980298. http://linkinghub.elsevier.com/retrieve/pii/S1526054204900656.
^ Yonath A, Bashan A (2004). "Ribosomal crystallography: initiation, peptide bond formation, and amino acid polymerization are hampered by antibiotics". Annu Rev Microbiol 58: 233–51. doi:10.1146/annurev.micro.58.030603.123822. PMID 15487937.
^ Khachatourians GG (November 1998). "Agricultural use of antibiotics and the evolution and transfer of antibiotic-resistant bacteria". CMAJ 159 (9): 1129–36. PMID 9835883. PMC 1229782. http://www.cmaj.ca/cgi/pmidlookup?view=reprint&pmid=9835883.
^ Fisher, Bruce; Harvey, Richard P.; Champe, Pamela C. (2007). Lippincott's Illustrated Reviews: Microbiology (Lippincott's Illustrated Reviews Series). Hagerstown, MD: Lippincott Williams & Wilkins. ISBN 0-7817-8215-5.
^ ^a ^b Unless else specified then ref is: Fisher, Bruce; Harvey, Richard P.; Champe, Pamela C. (2007). Lippincott's Illustrated Reviews: Microbiology (Lippincott's Illustrated Reviews Series). Hagerstown, MD: Lippincott Williams & Wilkins. pp. 332–353. ISBN 0-7817-8215-5.
^ Institut Pasteur Press Office - Vaccine against shigellosis (bacillary dysentery):a promising clinical trial 15 January 2009. Retrieved on 27 February 2009

[0] Fish DN (February 2002). "Optimal antimicrobial therapy for sepsis". Am J Health Syst Pharm 59 (Suppl 1): S13–9. PMID 11885408. http://www.ajhp.org/cgi/pmidlookup?view=long&pmid=11885408.

[1] Belland R, Ouellette S, Gieffers J, Byrne G (2004). "Chlamydia pneumoniae and atherosclerosis". Cell Microbiol 6 (2): 117–27. doi:10.1046/j.1462-5822.2003.00352.x. PMID 14706098.

[2] Heise E (1982). "Diseases associated with immunosuppression". Environ Health Perspect 43: 9–19. doi:10.2307/3429162. PMID 7037390.

[Saiman-3] Saiman L (2004). "Microbiology of early CF lung disease". Paediatr Respir Rev 5 (Suppl A): S367–9. doi:10.1016/S1526-0542(04)90065-6. PMID 14980298. http://linkinghub.elsevier.com/retrieve/pii/S1526054204900656.

[4] Yonath A, Bashan A (2004). "Ribosomal crystallography: initiation, peptide bond formation, and amino acid polymerization are hampered by antibiotics". Annu Rev Microbiol 58: 233–51. doi:10.1146/annurev.micro.58.030603.123822. PMID 15487937.

[5] Khachatourians GG (November 1998). "Agricultural use of antibiotics and the evolution and transfer of antibiotic-resistant bacteria". CMAJ 159 (9): 1129–36. PMID 9835883. PMC 1229782. http://www.cmaj.ca/cgi/pmidlookup?view=reprint&pmid=9835883.

[Microbiology-6] Fisher, Bruce; Harvey, Richard P.; Champe, Pamela C. (2007). Lippincott's Illustrated Reviews: Microbiology (Lippincott's Illustrated Reviews Series). Hagerstown, MD: Lippincott Williams & Wilkins. ISBN 0-7817-8215-5.

[MicrobiologyUnless-7] Unless else specified then ref is: Fisher, Bruce; Harvey, Richard P.; Champe, Pamela C. (2007). Lippincott's Illustrated Reviews: Microbiology (Lippincott's Illustrated Reviews Series). Hagerstown, MD: Lippincott Williams & Wilkins. pp. 332–353. ISBN 0-7817-8215-5.

[8] Institut Pasteur Press Office - Vaccine against shigellosis (bacillary dysentery):a promising clinical trial 15 January 2009. Retrieved on 27 February 2009

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