Significance and Roles of Proteus spp. Bacteria in Natural Environments

Proteus spp. bacteria were first described in 1885 by Gustav Hauser, who had revealed their feature of intensive swarming growth. Currently, the genus is divided into Proteus mirabilis, Proteus vulgaris, Proteus penneri, Proteus hauseri, and three unnamed genomospecies 4, 5, and 6 and consists of 80 O-antigenic serogroups. The bacteria are known to be human opportunistic pathogens, isolated from urine, wounds, and other clinical sources. It is postulated that intestines are a reservoir of these proteolytic organisms. Many wild and domestic animals may be hosts of Proteus spp. bacteria, which are commonly known to play a role of parasites or commensals. However, interesting examples of their symbiotic relationships with higher organisms have also been described. Proteus spp. bacteria present in soil or water habitats are often regarded as indicators of fecal pollution, posing a threat of poisoning when the contaminated water or seafood is consumed. The health risk may also be connected with drug-resistant strains sourcing from intestines. Positive aspects of the bacteria presence in water and soil are connected with exceptional features displayed by autochthonic Proteus spp. strains detected in these environments. These rods acquire various metabolic abilities allowing their adaptation to different environmental conditions, such as high concentrations of heavy metals or toxic substances, which may be exploited as sources of energy and nutrition by the bacteria. The Proteus spp. abilities to tolerate or utilize polluting compounds as well as promote plant growth provide a possibility of employing these microorganisms in bioremediation and environmental protection.

Bacterial translocation from the gastrointestinal tracts of rats receiving thermal injury

Rats receiving nonlethal thermal burns over 20 or 40% of their total body surface area were tested at various intervals for the translocation of indigenous bacteria from their gastrointestinal tracts to their mesenteric lymph nodes, peritoneal cavities, and bloodstreams. No indigenous bacteria were cultured from these organs of control rats or from rats receiving 20% burns. However, 44% of the rats receiving 40% burns exhibited viable Escherichia coli, Proteus mirabilis, Staphylococcus sp. and Clostridium sp. in their mesenteric lymph nodes 2 days after thermal injury. Bacterial translocation after burn stress also was tested in antibiotic-decontaminated rats monoassociated with E. coli. E. coli attained population levels in these animals of 10(8) to 10(9) per g cecum. E. coli translocated to 100% of the mesenteric lymph nodes of both the control and 40% burned rats. However, E. coli translocated at a greater incidence to the spleens, livers, and peritoneal cavities of the burned rats compared with translocation to these organs in control rats. The numbers of E. coli translocating to the mesenteric lymph nodes, spleens, and livers also were greater in the 40% burned rats than in control rats. By 14 days after thermal injury, the rats were able to clear E. coli from their spleens and livers, and the infection remained localized in the mesenteric lymph nodes. These results support the concept that the indigenous gastrointestinal flora or exogenous organisms colonizing the gastrointestinal tract are potential sources of septicemia after thermal injury.

Proteus spp. as Putative Gastrointestinal Pathogens

Proteus species, members of the Enterobacteriaceae family, are usually considered commensals in the gut and are most commonly recognized clinically as a cause of urinary tract infections. However, the recent identification of Proteus spp. as potential pathogens in Crohn's disease recurrence after intestinal resection serves as a stimulus to examine their potential role as gut pathogens. Proteus species possess many virulence factors potentially relevant to gastrointestinal pathogenicity, including motility; adherence; the production of urease, hemolysins, and IgA proteases; and the ability to acquire antibiotic resistance. Gastrointestinal conditions that have been linked to Proteus include gastroenteritis (spontaneous and foodborne), nosocomial infections, appendicitis, colonization of devices such as nasogastric tubes, and Crohn's disease. The association of Proteus species with Crohn's disease was particularly strong. Proteus species are low-abundance commensals of the human gut that harbor significant pathogenic potential; further investigation is needed.

Genetic and biochemical diversity of ureases of Proteus, Providencia, and Morganella species isolated from urinary tract infection

Bacterial urease, particularly from Proteus mirabilis, has been implicated as a contributing factor in the formation of urinary and kidney stones, obstruction of urinary catheters, and pyelonephritis. Weekly urine specimens (n = 1,135) from 32 patients, residing at two chronic-care facilities, with urinary catheters in place for greater than or equal to 30 days yielded 5,088 phenotypically and serotypically diverse bacterial isolates at greater than or equal to 10(5) CFU/ml. A total of 86% of specimens contained at least one urease-positive species, and 46% of 3,939 gram-negative bacilli were urease positive. For investigation of genetic relatedness of urease determinants, whole-cell DNA from 50 urease-positive isolates each of Providencia stuartii, Providencia rettgeri, P. mirabilis, Proteus vulgaris, and Morganella morganii were hybridized with a urease gene probe derived from within the urease operon of Providencia stuartii BE2467. The percentage of strains hybridizing with the gene probe was 98 for Providencia stuartii, 100 for Providencia rettgeri, 70 for P. mirabilis, 2 for M. morganii, and 0 for P. vulgaris. Electrophoretic mobilities of ureases from representative isolates revealed nine different patterns among the five species. The urease gene probe hybridized with fragments of HindIII-digested chromosomal DNA from all isolates except M. morganii. Fragment sizes differed between species. Molecular sizes of the enzymes, determined by Sephacryl S-300 chromatography, were found to be 280 kilodaltons (kDa) (P. mirabilis), 323 to 337 kDa (Providencia stuartii, Providencia rettgeri, P. mirabilis, P. vulgaris), 620 kDa (providencia rettgeri), and greater than 700 kDa (M. morganii, Providencia rettgeri). Kms ranged from 0.7 mM urea for M. morganii to 60 mM urea for a P. mirabilis isolate. In general, P. mirabilis ureases demonstrated lower affinities for substrate but hydrolyzed urea at rates 6- to 25-fold faster than did enzymes from other species, which may explain the frequent association of this species with stone formation.

Identification of two different hemolysin determinants in uropathogenic Proteus isolates

DNA sequences similar to those of the Escherichia coli hemolysin genes were detected among uropathogenic isolates of Proteus vulgaris and Morganella morganii by using the Southern blotting technique and hly gene-specific DNA probe. Immunoblotting revealed that among the hemolytic P. vulgaris and M. morganii isolates there was expressed a polypeptide species similar in molecular size (110 kilodaltons) and antigenicity to Escherichia coli HlyA. A plasmid-mediated P. vulgaris hemolysin determinant identified by Southern blotting analysis was molecularly cloned, and the recombinant plasmid (pWPV100) was characterized by restriction endonuclease fragment mapping. A second recombinant library of genomic DNA prepared from a hemolytic, urinary tract isolate of Proteus mirabilis was constructed in E. coli. A 5.5-kilobase XhoI fragment encoding an extracellular hemolytic activity was molecularly cloned (pWPM100), and this plasmid was subjected to transposon-mediated mutagenesis with TnphoA. The P. mirabilis hemolytic phenotype was determined to be encoded by a polypeptide species (HpmA) with an estimated molecular size of 140 kilodaltons based on minicell polypeptide analysis of pWPM100 and its mutant derivatives. Southern blotting analysis with a HpmA-specific DNA probe revealed that this novel determinant is commonly found in both Proteus species but is not present in hemolytic isolates of M. morganii, E. coli, Citrobacter freundii, and Serratia marcescens.

Potential virulence factors of Proteus bacilli

The object of this review is the genus Proteus, which contains bacteria considered now to belong to the opportunistic pathogens. Widely distributed in nature (in soil, water, and sewage), Proteus species play a significant ecological role. When present in the niches of higher macroorganisms, these species are able to evoke pathological events in different regions of the human body. The invaders (Proteus mirabilis, P. vulgaris, and P. penneri) have numerous factors including fimbriae, flagella, outer membrane proteins, lipopolysaccharide, capsule antigen, urease, immunoglobulin A proteases, hemolysins, amino acid deaminases, and, finally, the most characteristic attribute of Proteus, swarming growth, enabling them to colonize and survive in higher organisms. All these features and factors are described and commented on in detail. The questions important for future investigation of these facultatively pathogenic microorganisms are also discussed.

Cytotoxic activity of the Proteus hemolysin HpmA

We previously showed that hpmA is the hemolysin determinant most commonly found among Proteus isolates. To assess the potential contribution of HpmA to virulence, we first characterized the toxic activities of this hemolysin. Hemolytic activity was present in total cell cultures and cell-free supernatants of Proteus clinical isolates as well as Escherichia coli containing cloned hpm genes. HpmA also possesses cytotoxic activity which was detected by a chromium release assay against a variety of target cell lines (Daudi, Raji, T24, U937, and Vero). Analysis of the dose response of bacterial cells against both T24 cells and erythrocytes showed that E. coli containing cloned hpm genes was 30-fold more cytotoxic than Proteus mirabilis BA6163. Also, 10(5)-fold more bacterial cells were needed to lyse T24 cells than to lyse erythrocytes. HpmA- mutants of two Proteus strains in which the central portion of hpmA was deleted were constructed. These HpmA- mutants, which have lost the hemolytic and cytotoxic activities exhibited by their respective parent strains, demonstrate that HpmA is needed for both of these activities. In an ascending model of murine urinary tract infection, the hpmA mutant strain WPM111 behaved no differently from its parent strain, BA6163, with respect to either the level of kidney colonization or histopathological changes in the kidney. However, WPM111 had a sixfold higher 50% lethal dose than BA6163 when injected intravenously into C3H mice.

Occurrence and pathogenic role of Morganella-Proteus-Providencia group bacteria in human feces

A total of 2,693 fecal specimens, with 1,422 from healthy persons and 1,271 from patients suffering from enteric diseases, was investigated to isolate species of the Morganella-Proteus-Providencia group and to evaluate the role of these bacteria in intestinal disorders. Most strains were isolated from two media, i.e., blood agar and tryptophan agar. Two of the species were more frequently found in diarrheal cases than in healthy controls. These species were Morganella morganii and Proteus mirabilis. Two new species of Enterobacteriaceae, i.e., Proteus penneri and Providencia rustigianii, were found in 33 and 5 people, respectively. However, these two species were not found more frequently in the diarrheal cases.

Uropathogenicity in rats and mice of Providencia stuartii from long-term catheterized patients

Providencia stuartii, a frequent and persistent isolate from the urinary tract of chronically catheterized elderly patients, is multiply antibiotic resistant and may cause fatal bacteremia in those patients. We studied P. stuartii strains in rats and mice to determine differences in uropathogenicity. Strains studied varied in expression of factors which contribute to pathogenicity of other bacterial species. Urinary tract responses following challenge with P. stuartii strain HO (factors expressed) were similar to responses reported for uropathogenic E. coli strains both in bacterial persistence and histologic change. In animals similarly challenged with P. stuartii strain RO (factors not expressed), responses were similar to those reported for non-uropathogenic E. coli strains. Results indicate that: a) animal model studies may be useful in differentiating P. stuartii strains based on uropathogenicity, b) P. stuartii uropathogenicity may be related to identifiable factors associated with virulence in other species, and c) the CBA mouse model appears to be the most suitable for studies of P. stuartii uropathogenicity.

The ureases of Proteus strains in relation to virulence for the urinary tract

The ureases produced by a large number of strains of different Proteus species, some of which were known to have a special affinity for the urinary tract, were examined by polyacrylamide-gel electrophoresis. Each Proteus strain gave a pattern of urease isoenzymes that was characteristic and unique to its species although strains of P. Mirabilis and P. vulgaris gave isoenzyme patterns that were closely similar. There was some minor variation in the patterns of urease isoenzymes even between strains of the same species. This was most noticeable among P. rettgeri strains and to a lesser extent among P. vulgaris strains. No correlation was found between the types of ureases a strain produced and its pathogenicity for the urinary tract.

Proteus morgani is less frequently associated with urinary tract infections than Proteus mirabilis--an explanation

The metabolic activities of faecal and urinary strains of Proteus morgani and P. mirabilis were compared. Regardless of origin, the generation time of P. morgani strains in urine was approximately twice as long as that of the P. mirabilis strains. Urease synthesis was constitutive in P. morgani strains but required induction with urea in the P. mirabilis strains. In the presence of urea, the P. mirabilis strains liberated ammonia more rapidly and produced alkaline conditions more quickly than P. morgani strains, although they synthesized much less urease. These characteristics may place P. morgani strains at a disadvantage in comparison with P. mirabilis strains in their ability to cause urinary tract infections.

Mannose-resistant Proteus-like and P. mirabilis fimbriae have specific and additive roles in P. mirabilis urinary tract infections

Proteus mirabilis is an important uropathogen that can cause complicated urinary tract infections (UTI). It produces several types of fimbriae, including mannose-resistant Proteus-like (MR/P) fimbriae and P. mirabilis fimbriae (PMF). Previously, we determined that these fimbriae affect the ability of P. mirabilis to colonize the urinary tract. The objective of this study was to analyse the effect of the simultaneous lack of P. mirabilis MR/P and PMF fimbriae in UTI pathogenesis. A double mutant lacking both fimbriae was generated by allelic replacement mutagenesis. This mutant was characterized genetically and phenotypically, and tested using an in vitro uroepithelial cell adhesion assay and the ascending UTI murine model. In vitro adhesion to uroepithelial cells by the P. mirabilis pmfA/mrpA-D mutant was reduced when compared with the wild-type, although no significant differences were observed when it was compared with the single mrpA-D and pmfA mutants. However, in vivo assays showed that colonization of kidneys and bladders by the P. mirabilis pmfA/mrpA-D mutant was significantly reduced when compared with the wild-type and both single mutants. These results indicate that, although redundancy can occur, MR/P and PMF fimbriae have specific and additive roles in P. mirabilis UTI.

Providencia stuartii, a hospital pathogen: potential factors for its emergence and transmission

The emergence of Providencia stuartii as a hospital pathogen in a burn unit was demonstrated by routine infection surveillance. The organism was initially recognized in a burn wound and subsequently in urine or sputum. Compared to controls, those patients harboring P. stuartii were similar in age and percentage of body surface burned and were more likely to have been in one of the two burn unit rooms, (p less than 0.02). Infection with P. stuartii was independent of duration in the Intensive Care Unit or Burn Unit, and of number of visits to hydrotherapy or operating rooms (OR). Once patients were colonized with P. stuartii they had greater morbidity than non-colonized patients as evidenced by longer stays in the unit and increased visits to the OR for debridement. P. stuartii was isolated from air samples (5/14) more commonly than from the hands of personnel. In vitro tests suggested that extensive use of parenteral gentamicin and replacement of the antibacterial topical cream sulfamylon by silver sulfadiazine favored the emergence of P. stuartii over Pseudomonas aeruginosa as the predominant colonizing organism.

Hemolytic activity and invasiveness in strains of Proteus penneri

Twenty strains of Proteus penneri obtained from the Centers for Disease Control, Atlanta, Ga., were tested for their ability to hemolyze sheep and human erythrocytes, a property that is thought to be connected with the invasiveness and virulence of Proteus species. In the logarithmic phase of growth, P. penneri cultures are hemolytic for such erythrocytes. This ability is comparable to the hemolysis exhibited by nearly 100% of P. vulgaris and P. mirabilis strains, which is due to the production of a cell-bound hemolytic factor; is demonstrated only in broth cultures; and seems to facilitate the penetration of P. penneri and other Proteus species into the cells without cytotoxic effects. In contrast, a filterable alpha-hemolysin, which is produced transiently by a very few strains of P. mirabilis, was present in 4 of 20 P. penneri strains. This property, which is expressed at a high level over a long period, suggests a chromosomal origin. The penetration of an alpha-hemolytic P. penneri strain into Vero cells was accompanied by a drastic cytotoxic effect.

Prognosis Risk of Urosepsis in Critical Care Medicine: A Prospective Observational Study

This study aimed to investigate the clinical features of urosepsis and to raise awareness of this problem. Of the 112 sepsis patients enrolled, 36 were identified as having urosepsis. The bacteria involved in the infection leading to urosepsis included Escherichia coli, Proteus species, Enterococcus species, Klebsiella species, other Gram-positive cocci, and Pseudomonas aeruginosa. Although the organ/system dysfunction appeared earlier in the urosepsis patients than in the other sepsis patients (4.7 ± 2.4 versus 7.2 ± 4.5 hours, P < 0.001), the urosepsis patients presented with a better prognosis and lower 28-day mortality rate than the others (6% versus 37%). In the multivariate analysis, the type of sepsis (urosepsis, OR = 0.019, 95% CI = 0.001, 0.335, P = 0.007) and SOFA score (OR = 1.896, 95% CI = 1.012, 3.554, P = 0.046) remained significantly associated with the survival. The time of admission to the intensive care unit of 17 patients transferred from the Department of Urinary Surgery was significantly prolonged compared with those transferred from other departments (11.6 ± 7.3 versus 7.2 ± 4.9 hours, P < 0.05). In conclusion, urosepsis suggested a better prognosis, but attention needs to be paid in clinical practice, especially in urinary surgery.

Susceptibility of Human Pathogenic Bacteria to Antimicrobial Peptides from Sesame Kernels

Hospital infection caused by Gram-negative bacteria is a serious and common problem, especially in developing countries. Aiming to reduce these infections, this report focuses on the identification and characterization of novel antimicrobial peptides from sesame (Sesamum indicum) kernel meals. Thus, sesame flour was extracted and precipitated with ammonium sulfate (100%). After dialysis, a rich fraction was applied to affinity red-Sepharose CL-6B chromatography, followed by reversed-phase high-performance liquid chromatography. Mass spectrometry analysis indicated the presence of a major peptide with molecular mass of approximately 5.8 kDa in both cultivars. The bactericidal activities of antimicrobial peptides were evaluated against several human pathogens that had been effective only against Klebsiella sp., a Gram-negative bacterium responsible for human urinary infection. These data indicate the biotechnological potential of sesame peptides as an alternative method for hospital infection control and also the decrease of bacterial resistance to synthetic antibiotics.

An urgent problem of aerobic gram-negative pathogen infection in complicated parapneumonic effusions or empyemas

OBJECTIVES

Complicated parapneumonic effusion or empyema is a troublesome disease with a high mortality. The most common involved microorganisms seem to have changed over recent decades, influenced by the introduction of new antibiotics, and the increase of immunocompromised hosts, and the elderly population. More epidemiological studies on the current bacteriology are needed to help us to empirically select adequate antibiotics.

DESIGN

A retrospective study via chart review in a university-affiliated tertiary medical center was conducted to assess the underlying bacterial pathogens and outcome of patients with complicated parapneumonic effusions or empyemas.

RESULTS

During the 43-month study period (from December 2000 to June 2004), 304 patients were diagnosed with complicated parapneumonic effusions or empyemas and the mortality of these patients was 23% (69/304). Among these 304 patients, a total of 292 microorganisms were cultured from the pleural fluid samples of 207 patients (to yield a positive microbiological culture rate of 68% (207/304). Isolated bacteria included aerobic Gram-negative bacteria (n=129), aerobic Gram-positive bacteria (n=105), anaerobic bacteria (n=51), and M. tuberculosis (n=7). Of these aerobic bacterial infections, Gram-negative bacteria were isolated more frequently from the older population and involved a significantly higher mortality rate and longer stay, compared to those with other bacteria (p=0.001 and p<0.001 respectively).

CONCLUSION

The increasing incidence of infection with aerobic Gram-negative pathogens may cause more critical conditions in complicated parapneumonic effusions or empyemas.

The production of HlyA toxin by Proteus penneri strains

Twelve diverse strains of Proteus penneri of clinical origin all produced a calcium-dependent haemolysin, unlike most other Proteus spp. In most strains the haemolysin was secreted into the medium during early exponential growth and lysed not only of a variety of erythrocyte types from several animals including man, but also human neutrophils and human embryo lung fibroblasts. The haemolysin was a protein of 107 kDa, the same size as Escherichia coli HlyA, and it reacted with antiserum to E. coli HlyA. Because of its similarity in size, antigenicity and range of action to the HlyA virulence factor of E. coli, P. penneri HlyA is believed to be an important virulence factor for this organism. It was degradable by an EDTA-sensitive protease--probably the IgA protease--to inactive fragments. The interaction of P. penneri HlyA and IgA protease in vivo and the origin of HlyA, which has now been found in many diverse bacteria, are discussed.

Biological activities of lipopolysaccharides of Proteus spp. and their interactions with polymyxin B and an 18-kDa cationic antimicrobial protein (CAP18)-derived peptide

The saccharide constituents of lipopolysaccharides (LPS) of Proteus spp. vary with the strain and contain unique components about which little is known. The biological activities of LPS and lipid A from S- and R-forms of 10 Proteus strains were examined. LPS from all S-form Proteus strains was lethal to D-(+)-galactosamine (GalN)-loaded, LPS-responsive, C3H/HeN mice, but not to LPS-hypo-responsive C3H/HeJ mice. P. vulgaris 025 LPS evoked strong anaphylactoid reactions in N-acetylmuramyl-L-alanyl-D-isoglutamine (MDP)-primed C3H/HeJ mice. LPS from S- and R-form Proteus strains induced production of nitric oxide (NO) and tumour necrosis factor (TNF) by macrophages isolated from C3H/HeN but not C3H/HeJ mice. Lipid A from Proteus strains also induced NO and TNF production, although lipid A was less potent than LPS. The effects of LPS were mainly dependent on CD14; LPS-induced NO and TNF production in CD14+ J774.1 cells was significantly greater than in CD14-J7.DEF.3 cells. All LPS from Proteus strains, and especially from P. vulgaris 025, exhibited higher anti-complementary activity than LPS from Escherichia coli or Pseudomonas aeruginosa. Polymyxin B inactivated proteus LPS in a dose-dependent manner, but these LPS preparations were more resistant to polymyxin B than E. coli LPS. CAP18(109-135), a granulocyte-derived peptide, inhibited proteus LPS endotoxicity only when the LPS:CAP18(109-135) ratio was appropriate, which suggests that CAP18(109-135) acts through a different mechanism than polymyxin B. The results indicate that LPS from Proteus spp. are potently endotoxic, but that the toxicity is different from that of LPS from E. coli or Salmonella spp. and even varies among different Proteus strains. The variation in biological activities among proteus LPS may be due to unique components within the respective LPS.

Bacterial interference induced in embryonated eggs by staphylococci

Studies of experimental infections in embryonated eggs demonstrated that prior allantoic infection with avirulent staphylococci afforded significant protection against subsequent challenge with virulent strains. All strains of coagulase-positive and coagulase-negative staphylococci tested that were relatively avirulent for embryonated eggs were capable of producing interference. The interference induced afforded protection not only against challenge with virulent staphylococci, but also against Diplococcus pneumoniae, Salmonella typhimurium, Escherichia coli, Proteus mirabilis, and one strain of influenza virus (A(2)J 305). Prior allantoic infection with avirulent staphylococci also protected against intravenous as well as allantoic infection with challenge strains.Interference required infection with viable bacteria. The onset of interference appeared within a few minutes after injection of the interfering strain, but was not maximal until 24 hours had elapsed between injection of the interfering and challenge strains. The protection afforded by the production of interference could not be overcome by increased inoculum size of the challenge strain and extended even to challenge with 10(9) bacteria. Studies of in vitro and in vivo growth of challenge strains in allantoic fluid demonstrated that some interfering strains inhibited growth of the challenge strains. Other strains produced interference without producing prolonged inhibition of the growth of challenge strains. Similarly, interference could not be attributed to attenuated virulence of the challenge organisms. All interfering strains studied produced enhanced bactericidal activity of whole blood from the affected embryos, but whether this affected leukocyte activity, opsonization, or other host defense mechanisms has yet to be determined.