Proteus mirabilis and Klebsiella pneumoniae as pathogens capable of causing co-infections and exhibiting similarities in their virulence factors

The genera Klebsiella and Proteus were independently described in 1885. These Gram-negative rods colonize the human intestinal tract regarded as the main reservoir of these opportunistic pathogens. In favorable conditions they cause infections, often hospital-acquired ones. The activity of K. pneumoniae and P. mirabilis, the leading pathogens within each genus, results in infections of the urinary (UTIs) and respiratory tracts, wounds, bacteremia, affecting mainly immunocompromised patients. P. mirabilis and K. pneumoniae cause polymicrobial UTIs, which are often persistent due to the catheter biofilm formation or increasing resistance of the bacteria to antibiotics. In this situation a need arises to find the antigens with features common to both species. Among many virulence factors produced by both pathogens urease shows some structural similarities but the biggest similarities have been observed in lipids A and the core regions of lipopolysaccharides (LPSs). Both species produce capsular polysaccharides (CPSs) but only in K. pneumoniae these antigens play a crucial role in the serological classification scheme, which in Proteus spp. is based on the structural and serological diversity of LPS O-polysaccharides (OPSs). Structural and serological similarities observed for Klebsiella spp. and Proteus spp. polysaccharides are important in the search for the cross-reacting vaccine antigens.

The prevailing O serogroups among the serologically differentiated clinical Proteus spp. strains in central Poland

In the years 2006–2011, 617 Proteus spp. strains isolated mostly from urine and wounds or other clinical sources were collected in Łódź, Poland, to determine the offensive O serotypes frequently occurring among patients. P. mirabilis exhibited the most intensive swarming growth and was dominating species (86.9%), followed by P. genomospecies, P. vulgaris, and P. penneri. Ninety four per cent strains were recognized as S (smooth) forms. Serological studies (involving ELISA—enzyme-linked immunosorbent assay and Western blotting using native and adsorbed rabbit antisera) enabled classification of 80% S isolates into respective Proteus O serogroups among the 83 ones, described so far. The remaining strains seemed to be serologically unique. Despite the observed big serological variety of Proteus spp. isolates, we found the O78 serogroup recently described in Poland as dominating and identified other widespread serotypes: O3, O6, O10, O11, O27, O28, and O30 reported earlier as predominating also in other countries; O77 and O79 detected lately in Poland; O16, O18, O20, and O50. No unique structural feature of the prevalent O serotypes has been indicated. However, the prevalence of some O serogroups indicates that particular serotypes may be in some ways beneficial to the strains producing these kinds of O antigen.

Structural and serological characterization of the O82 antigen of a Proteus mirabilis strain isolated from a patient in Poland

P. mirabilis strains Kro 45 and Kwy 46 were isolated from the pus and the muscular fluid, respectively, of a hospitalized 61-year-old female in Łódź, Poland. Both strains demonstrated a good swarming ability on a solid medium, and the Dienes test for differentiation of swarming strains indicated their identity. The strains were serologically identical and did not belong to any of the known Proteus O1-O81 serogroups. In this work, we studied the O-specific polysaccharide (O antigen) of P. mirabilis Kwy46, which defines the immunospecificity of the strain. The O-polysaccharide was obtained by mild acid degradation of the lipopolysaccharide, and the following structure of its oligosaccharide repeat (O-unit) was established by sugar analysis along with 1D and 2D ¹H and ¹³C NMR spectroscopy: where (S)-lac indicates an (S)-1-carboxyethyl group [an (S)-lactic acid residue], which forms an ether with a GlcNAc residue (so called glycolactilic acid). This structure is unique among Proteus O-polysaccharides but shares a trisaccharide fragment with that of P. mirabilis O5. Studies of the cross-reactivity between P. mirabilis Kwy 46 O antiserum/lipopolysaccharide and Proteus O1-O81 lipopolysaccharides/O antisera allowed identification of a putative Kwy 46 O-antigen epitope. Based on the data obtained, it is proposed to create a new O82 serogroup within the genus Proteus represented by the studied P. mirabilis isolates.

Structures and serospecificity of threonine-containing O polysaccharides of two clinical isolates belonging to the genus Proteus and their classification into O11 subserogroups

Two clinical isolates from Polish patients, Proteus mirabilis 9B-m and Proteus genomospecies 3J-r, were found to be serologically related to P mirabilis O11. However, serological studies involving ELISA and Western blotting methods, using lipopolysaccharides (LPSs) extracted from the strains as antigens and native or adsorbed rabbit polyclonal O antisera, specific to the studied strains, revealed slight differences in the cross-reactivity and specificity of the two studied Proteus isolates, when compared to P. mirabilis O11. Two different O polysaccharides containing N-(d-galacturonoyl)-l-threonine were isolated from the LPSs of the isolates. Their structures were determined by chemical analysis and NMR spectroscopy and found to be related to the P. mirabilis O11 antigen structure established earlier, the 9B-m structure differing in the absence of the lateral glucose residue and the 3J-r structure in non-stoichiometric O-acetylation of the threonine residue only. Thus, the Proteus O11 serogroup should be divided into two subgroups: O11a, represented by the 9B-m isolate and O11a, b possessing the additional b epitope, containing the lateral residue of glucose and formed by the 3J-r isolate as well as P. mirabilis 25/57 belonging to O11 serogroup so far. O11a is the sixth new serotype found in Proteus spp. strains recently isolated from patients in central Poland.