Proteus Mirabilis

Proteus mirabilis is a Gram-negative, facultatively anaerobic bacterium. It shows swarming motility, and urease activity. P. mirabilis causes 90% of all 'Proteus' infections. It belongs to the Tribe Proteae.

Diagnosis

An alkaline urine sample is a possible sign of P. mirabilis.

P. mirabilis can be diagnosed in the lab due to characteristic swarming motility, and inability to metabolize lactose (on a MacConkey agar plate, for example.) Also P. mirabilis produces a very distinct odour.

Disease

This rod shaped bacterium has the ability to produce high levels of urease. Urease hydrolyzes urea to ammonia (NH₃) and thus makes the urine more alkaline. If left untreated, the increased alkalinity can lead to the formation of crystals of struvite, calcium carbonate, and/or apatite. The bacteria can be found throughout the stones, and these bacteria lurking in the stones can reinitiate infection after antibiotic treatment. Once the stones develop, over time they may grow large enough to cause obstruction and renal failure. Proteus can also cause wound infections, septicemia and pneumonias, mostly in hospitalized patients.

Treatment

P. mirabilis is generally susceptible to most antibiotics apart from tetracycline, however 10%–20% of P. mirabilis strains are also resistant to first generation cephalosporins and ampicillins.

Characteristics

P. mirabilis can utilize urea and citrate. It can produce hydrogen sulfide gas, and forms clear films on growth media. It is motile, possessing peritrichous flagella, and is known for its swarming ability. It is commonly found in the intestinal tract of humans. P. mirabilis is not pathogenic in guinea pigs or chickens. Noteworthy is the ability of this species to inhibit growth of unrelated strains resulting in a macroscopically visible line of reduced bacterial growth where two swarming strains intersect. This line is named Dienes line after its discoverer Louis Dienes.

The micro-organism tests:

• Indole negative and Nitrate reductase positive (no gas bubbles produced)
• Methyl Red positive and Voges-Proskauer negative
• Catalase positive and Cytochrome Oxidase negative
• Phenylalanine Deaminase positive

Proteus Vulgaris

Proteus vulgaris is a rod-shaped, Gram negative bacterium that inhabits the intestinal tracts of humans and animals. It can be found in soil, water and faecal matter. It is grouped with the enterobacteriaceae and is an opportunistic pathogen of humans. It is known to cause urinary tract infections and wound infections.

Notation: Known antibiotics that P. vulgaris is sensitive to:

Ciprofloxacin, Ceftazidime, Netilmicin, Sulbactam or Cefoperazo, Meropenem, Piperacil or Tazobactam, Unasyn.

Antibiotics should be introduced in much higher doses than "normal" when P. vulgaris has infected the sinus or respiratory tissues. I.E.- Ciprofloxacin should be introduced at a level of at least 2000mg per day orally in such a situation, rather than the "standard" 1000mg per day.

According to laboratory conducted fermentation tests, "P. vulgaris" ferments glucose, sucrose, and amygdalin, but does not ferment lactose or mannitol. "P. vulgaris" also tests positive for the Methyl Red (mixed acid fermentation) test and is also an extremely motile organism.

When "P. vulgaris" is tested using the API 20E Identification System [1] test strip for Enterobacteriaceae (made by BIOMERIEUX) [2], it is discovered that it provides a positive result for: sulfur reduction, urease production, tryptophan deaminase production, and indole production, and provides a negative result for the remainder of the tests on the testing strip.

It is referenced in the Analytical Profile Index using the seven-digit code: 0474021

The optimal growing conditions of this organism is in a facultative anaerobic environment with an average temperature of about 23 degrees Celsius .

The term Proteus signifies changeability of form, as personified in the Homeric poems in Proteus, "the old man of the sea," who tends the sealflocks of Poseidon and has the gift of endless transformation. The first use of the term “Proteus” in bacteriological nomenclature was made by Hauser (1885) who described under this term three types of organisms which he isolated from putrefied meat. One of the three species Hauser identified was Proteus vulgaris so this organism has a long history in Microbiology.

Over the past two decades the genus Proteus, and in particular P. vulgaris, has undergone a number of major taxonomic revisions. In 1982, P. vulgaris was separated into three biogroups on the basis of indole production. Biogroup one was indole negative and represented a new species: P. penneri; while biogroup two and three remained together as P. vulgaris.

Proteus

Background

Proteus species are part of the Enterobacteriaceae family of gram-negative bacilli. Proteus organisms are implicated as serious causes of infections in humans, along with Escherichia, Klebsiella, Enterobacter, and Serratia species. Proteus species are most commonly found in the human intestinal tract as part of normal human intestinal flora, along with Escherichia coli and Klebsiella species, of which E coli is the predominant resident. Proteus is also found in multiple environmental habitats, including long-term care facilities and hospitals. In hospital settings, it is not unusual for gram-negative bacilli to colonize both the skin and oral mucosa of both patients and hospital personnel. Infection primarily occurs from these reservoirs. However, Proteus species are not the most common cause of nosocomial infections

Proteus mirabilis causes 90% of Proteus infections and can be considered a community-acquired infection. Proteus vulgaris and Proteus penneri are easily isolated from individuals in long-term care facilities and hospitals and from patients with underlying diseases or compromised immune systems.

Patients with recurrent infections, those with structural abnormalities of the urinary tract, those who have had urethral instrumentation, and those whose infections were acquired in the hospital have an increased frequency of infection caused by Proteus and other organisms (eg, Klebsiella, Enterobacter, Pseudomonas, enterococci, staphylococci).

Pathophysiology

Proteus species possess an extracytoplasmic outer membrane, a feature shared with other gram-negative bacteria. In addition, the outer membrane contains a lipid bilayer, lipoproteins, polysaccharides, and lipopolysaccharides.

Infection depends on the interaction between the infecting organism and the host defense mechanisms. Various components of the membrane interplay with the host to determine virulence. Inoculum size is important and has a positive correlation with the risk of infection.

Certain virulence factors have been identified in bacteria. The first step in the infectious process is adherence of the microbe to host tissue. Fimbriae facilitate adherence and thus enhance the capacity of the organism to produce disease. E coli, P mirabilis, and other gram-negative bacteria contain fimbriae (ie, pili), which are tiny projections on the surface of the bacterium. Specific chemicals located on the tips of pili enable organisms to attach to selected host tissue sites (eg, urinary tract endothelium). The presence of these fimbriae has been demonstrated to be important for the attachment of P mirabilis to host tissue.

The attachment of Proteus species to uroepithelial cells initiates several events in the mucosal endothelial cells, including secretion of interleukin 6 and interleukin 8. Proteus organisms also induce apoptosis and epithelial cell desquamation. Bacterial production of urease has also been shown to increase the risk of pyelonephritis in experimental animals. Urease production, together with the presence of bacterial motility and fimbriae, may favor the production of upper urinary tract infections (UTIs) by organisms such as Proteus.

Enterobacteriaceae (of which Proteus is a member) and Pseudomonas species are the microorganisms most commonly responsible for gram-negative bacteremia. When these organisms invade the bloodstream, endotoxin, a component of gram-negative bacterial cell walls, apparently triggers a cascade of host inflammatory responses and leads to major detrimental effects. Because Proteus and Pseudomonas organisms are gram-negative bacilli, they can cause gram-negative endotoxin-induced sepsis, resulting in systemic inflammatory response syndrome (SIRS). SIRS has a mortality rate of 20-50%.

Although other organisms can trigger a similar response, it is useful to consider gram-negative bacteremia as a distinct entity because of its characteristic epidemiology, pathogenesis, pathophysiology, and treatment. The presence of the sepsis syndrome associated with a UTI should raise the possibility of urinary tract obstruction. This is especially true of patients who reside in long-term care facilities, who have long-term indwelling urethral catheters, or who have a known history of urethral anatomic abnormalities.

The ability of Proteus organisms to produce urease and to alkalinize the urine by hydrolyzing urea to ammonia makes it effective in producing an environment in which it can survive. This leads to precipitation of organic and inorganic compounds, which leads to struvite stone formation. Struvite stones are composed of a combination of magnesium ammonium phosphate (struvite) and calcium carbonate-apatite.

Struvite stone formation can be sustained only when ammonia production is increased and the urine pH is elevated to decrease the solubility of phosphate. Both of these requirements can occur only when urine is infected with a urease-producing organism such as Proteus. Urease metabolizes urea into ammonia and carbon dioxide: Urea ® 2NH₃ + CO₂. The ammonia/ammonium buffer pair has a pK of 9.0, resulting in the combination of highly alkaline urine rich in ammonia.

Symptoms attributable to struvite stones are uncommon. More often, women present with UTI, flank pain, or hematuria and are found to have a persistently alkaline urine pH (>7.0).

Frequency

United States

The genitourinary tract is the site of disease responsible for gram-negative bacteremia in approximately 35% of patients. In previously healthy outpatients, E coli is by far the most often implicated cause of UTIs. In contrast, individuals with multiple prior episodes of UTI, multiple antibiotic treatments, urinary tract obstruction, or infection developing after instrumentation frequently become infected with Proteus bacteria or other bacteria such as Enterobacter, Klebsiella, Serratia, and Acinetobacter.

Bacteriuria occurs in 10-15% of hospitalized patients with indwelling catheters. The risk of infection is 3-5% per day of catheterization.

Mortality/Morbidity

Among long-term care residents, UTIs are the second most common infection responsible for hospital admission, second only to pneumonia. UTIs can result in sepsis if not recognized and treated rapidly. Failure to treat or a delay in treatment can result in SIRS. The mortality rate for SIRS is 20-50%.

Sex

Other factors that increase infection rates are female sex, duration of catheterization, underlying illness, faulty catheter care, and lack of systemic antibiotic therapy. Infection occurs either by migration of bacteria up the catheter along the mucosal sheath or by migration up the catheter lumen from infected urine.

• UTIs are the most common clinical manifestation of Proteus infections. Proteus infection accounts for 1-2% of UTIs in healthy women and 5% of hospital-acquired UTIs. Complicated UTIs (ie, those associated with catheterization) have a prevalence of 20-45%.
• UTIs are more common in males then females in the neonatal population. This is a result of congenital abnormalities seen more often in males.
• After the age of 50 years, the ratio between men and women begins to decline because of the increasing incidence of prostate disease. UTIs in men younger than 50 years are usually caused by urologic abnormalities.

Age

UTIs are more common in persons aged 20-50 years.

Sindrom Proteus

Sindrom Proteus adalah kelainan bawaan yang menyebabkan pertumbuhan kulit secara berlebihan dan perkembangan tulang yang tidak umum, sering juga disertai tumor pada sebagian tubuh.
Sindrom Proteus sangat langka. Sejak Dr. Michael Cohen mengidentifikasikan sindrom ini pada 1979, hanya sekitar 200 kasus dikonfirmasi di seluruh dunia, dengan perkiraan sekitar 120 orang yang mengalami kondisi ini sekarang.

Kondisi ini sangatlah langka, dan mungkin tidak akan pernah diketahui jika tidak ada fakta bahwa Joseph Merrick - lebih dikenal dengan julukan "Elephant Man" manusia gajah karena tumor besar di wajahnya dan warna keabu-abuan kelebihan kulitnya - yang kemudian didiagonisis memiliki kasus parah Proteus sindrom. Anehnya, lengan kiri Merrick dan genital-nya seluruhnya tidak terkena efek oleh kondisi yang mengubah bentuk bagian tubuhnya yang lain.

Sindrom Proteus menyebabkan pertumbuhan kulit, tulang, otot, jaringan lemak, pembuluh darah dan limfa secara berlebihan.
Sindrom Proteus merupakan kondisi yang progresif, di mana anak yang terkena sindrom Proteus dillahirkan tanpa perubahan bentuk apapun yang jelas. Seiring dengan bertambahnya umur mereka, tumor mulai muncul, juga pertumbuhan kulit dan tulang. Keparahan dan lokasi dari pertumbuhan asimetris ini beragam, tapi umumnya tengkorak, satu atau lebih anggota badan, dan telapak kaki akan terkena efek. Ada risiko kematian prematur pada individu dengan sindrom Proteus karena deep vein thrombosis dan pulmonary embolism yang disebabkan oleh malformasi pembuluh yang berkaitan dengan kelainan ini. Risiko lebih lanjut mungkin terjadi karena kelebihan jaringan - Merrick sendiri mati ketika dia tercekik oleh berat kepalanya sendiri ketika sedang tidur.
Kelainan ini dapat diderita kedua gender dengan rasio sama, dan dapat ditemukan pada semua etnis.
Kelainan ini tidak secara langsung menyebabkan kelambatan belajar: distribusi intelijensi di antara para penderita sindrom Proteus mencerminkan populasi pada umumnya, pertumbuhan mungkin menyebabkan kerusakan sekunder pada sistem saraf yang menyebabkan cacat kognitif. Sebagai tambahan, perubahan bentuk yang kelihatan dapat memberikan dampak negatif pada pengalaman sosial penderita, menyebabkan defisit kognitif dan sosial.

Para peneliti masih mencoba untuk menentukan penyebab sindrom Proteus. Beberapa riset menunjukkan kondisi ini berkaitan dengan PTEN pada kromosom 10, sementara riset lain menunjuk pada kromosom 16.

Dokter hanya bisa mengatasi beberapa gejala (misalnya, dengan menghilangkan tumor). Selain itu belum diketahui penyembuhannya.

Tugas Akhir apa Turun Angkatan?

Fiuuhhh..Akhirnya masa-masa yang aku nantikan datang juga..TA bow..Kalo sebelum-sebelumnya TA ku identik dengan Turun Angkatan alias ngulang akhirnya sekarang TA beneran..Cuma masalahnya judulnya kok susah nyarinya ya..Banyak banget pertimbangan dari ngambil tema ampe judul..Huuuh..Setelah dipikir-pikir dengan matang kayaknya RPL bisa masuk di otak aku..Secara gitu loh kalo ITP ama SKJK kayaknya nilai-nilainya ga meyakinkan..Pengen cepet-cepet keluar dari kampus ini..Soalnya jalan hidup aku bakal dimulai setelah keluar dari kampus ini..Pengennya sih TA nya lancar tanpa ada kendala..Cuman kan manusia hanya berusaha Allah maha penentu..Semoga semuanya berjalan tanpa halangan..Amien..

6 Juli 2008

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Kau bidadariku..penerang sukmaku..semangat hidupku..
Terima kasih cinta..


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