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      Isolation, identification & characterization of Proteus penneri - a missed rare pathogen

      research-article
      The Indian Journal of Medical Research
      Medknow Publications & Media Pvt Ltd
      Dienes, indole, MDR, proteus, Proteus penneri, swarming

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          Abstract

          Background & objectives:

          Indole negative Proteus species are invariably incorrectly identified as P. mirabilis, missing isolates of Proteus penneri. P. penneri is an invasive pathogen capable of causing major infectious diseases still seldom reported in individual cases. We report here the isolation, differentiation, characterization and typing of P. penneri from patients with different clinical infections.

          Methods:

          Urine, pus and body fluids collected from patients in intensive care units, wards and out patients departments of a tertiary health care institute from north India were cultured. A total of 61 indole negative Proteus isolates were subjected to extended biochemical tests to differentiate and identify P. penneri from P. mirabilis including failure to produce ornithine decarboxylase (by 0% strains of P. penneri and 100% strains of P. mirabilis) besides P. penneri being uniformly salicin negative, non-utilizer of citrate but ferments sucrose and maltose. Antibiograms and Dienes phenomenon were performed to characterize and type P. penneri isolates besides screening for β-lactamase production.

          Results:

          Eight isolates of P. penneri were identified; four from urine, three from abdominal drain-fluid and one from diabetic foot ulcer. P. penneri was isolated as the sole pathogen in all patients having underlying disease; post-operatively. Swarming was not seen in the first strain on primary isolation and was poor in strain-4. All eight isolates were biochemically homologous but multi-drug resistant (MDR) with resistance to 6-8 drugs (up to 12). β-lactamase production was seen in three of five isolates while Dienes phenomenon found four distinct types and discriminated strains differing in resistance even with a single drug.

          Interpretation & Conclusions:

          A few additional biochemical tests identified P. penneri isolates; it infected patients with underlying disease and strains were MDR and heterogenous.

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          Most cited references22

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          Classification, identification, and clinical significance of Proteus, Providencia, and Morganella.

          This review presents the current taxonomy of the genera Proteus, Providencia, and Morganella, along with the current methods for the identification of each species within the three genera, incorporating both conventional biochemical and commercial methods. While all of these organisms are ubiquitous in the environment, individual case reports and nosocomial outbreak reports that demonstrate their ability to cause major infectious disease problems are presented. Lastly, anticipated antimicrobial susceptibility patterns are reviewed. Many of these organisms are easily controlled, but the advent of newer and more powerful antimicrobial agents has led to some problems of which laboratorians need to be aware.
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            The Dienes phenomenon: competition and territoriality in Swarming Proteus mirabilis.

            When two different strains of swarming Proteus mirabilis encounter one another on an agar plate, swarming ceases and a visible line of demarcation forms. This boundary region is known as the Dienes line and is associated with the formation of rounded cells. While the Dienes line appears to be the product of distinction between self and nonself, many aspects of its formation and function are unclear. In this work, we studied Dienes line formation using clinical isolates labeled with fluorescent proteins. We show that round cells in the Dienes line originate exclusively from one of the swarms involved and that these round cells have decreased viability. In this sense one of the swarms involved is dominant over the other. Close cell proximity is required for Dienes line formation, and when strains initiate swarming in close proximity, the dominant Dienes type has a significant competitive advantage. When one strain is killed by UV irradiation, a Dienes line does not form. Killing of the dominant strain limits the induction of round cells. We suggest that both strains are actively involved in boundary formation and that round cell formation is the result of a short-range killing mechanism that mediates a competitive advantage, an advantage highly specific to the swarming state. Dienes line formation has implications for the physiology of swarming and social recognition in bacteria.
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              Bacteraemia due to tribe Proteeae: a review of 132 cases during a decade (1991-2000).

              To characterize the clinical features of bacteraemia due to tribe Proteeae, 132 cases among 130 patients from 1991 to 2000 were analysed. The organisms included the Proteus species in 63 cases (P. mirabilis in 41, P. penneri in 2 and P. vulgaris in 20), the Providencia species in 8 (P. rettgeri in 3 and P. stuartii 5) and Morganella morganii in 61. Morganella bacteraemia occurred more frequently in the hospital (70.5%). Biliary and hepatic diseases were predominant in cases with Morganella bacteraemia while cardiovascular, urological and neurological diseases were more common in cases with Proteus bacteraemia. Biliary drainage catheters had more frequently been placed in cases with Morganella bacteraemia (39.3%, p < 0.001), and urinary catheters more frequently in cases with Proteus bacteraemia (17.5%). Biliary infection was most common in cases with Morganella bacteraemia (49.2%), while urinary tract infection (UTI) was most common in cases with Proteus bacteraemia (47.6%). Mortality directly related to bacteraemia due to tribe Proteeae was 20.8% (22.6, 50.0 and 15.0% for Proteus, Providencia and Morganella bacteraemia, respectively). In conclusion, Morganella bacteraemia was most frequently associated with biliary infection, while Proteus bacteraemia was most frequently with UTI. Providencia bacteraemia was relatively uncommon and it can be associated with infections other than UTI.
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                Author and article information

                Journal
                Indian J Med Res
                Indian J. Med. Res
                IJMR
                The Indian Journal of Medical Research
                Medknow Publications & Media Pvt Ltd (India )
                0971-5916
                March 2012
                : 135
                : 3
                : 341-345
                Affiliations
                [1] Department of Microbiology, Sanjay Gandhi Post-Graduate Institute of Medical Sciences, Lucknow, India
                Author notes
                Reprint requests: Dr Janak Kishore, Professor, Department of Microbiology, Sanjay Gandhi Post-Graduate Institute of Medical Sciences, Lucknow 226 014, India e-mail: janaksgpi@ 123456yahoo.co.in
                Article
                IJMR-135-341
                3361870
                22561620
                550a8ad2-3089-4de4-bc6c-d21fae69cd30
                Copyright: © The Indian Journal of Medical Research

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 04 March 2010
                Categories
                Original Article

                Medicine
                proteus penneri,indole,dienes,mdr,proteus,swarming
                Medicine
                proteus penneri, indole, dienes, mdr, proteus, swarming

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