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Pathogenic bacteria

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Bacterial infection
Clostridium tetani 01.png
Clostridium tetani is a pathogenic bacterium that causes tetanus
Classification and external resources
Specialty Lua error in Module:Wikidata at line 446: attempt to index field 'wikibase' (a nil value).
Patient UK Pathogenic bacteria
MeSH D001424
[[[d:Lua error in Module:Wikidata at line 863: attempt to index field 'wikibase' (a nil value).|edit on Wikidata]]]

Pathogenic bacteria are bacteria that can cause infection. This article deals with human pathogenic bacteria.

Although most bacteria are harmless or often beneficial, several are pathogenic. One of the bacterial diseases with the 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. Pathogenic bacteria are also the cause of high infant mortality rates in developing countries.[1]

Koch's postulates are the standard to establish a causative relationship between a microbe and a disease.

Diseases

Each species has specific effect and causes symptoms in people who are infected. Some, if not most people who are infected with a pathogenic bacteria do not have symptoms. Immuno-compromised individuals are more susceptible to pathogenic bacteria.

Pathogenic susceptibility

Some pathogenic bacteria cause disease under certain conditions, such entry through the skin via a cut, through sexual activity or an compromised immune function.

Streptococcus and Staphylococcus are part of the normal skin microbiota and typically reside on healthy skin or in the nasopharangeal region. Yet these species can potentially initiate skin infections. They are also able to cause sepsis, pneumonia, meningitis. These infections can become quite serious creating a systemic inflammatory response resulting in massive vasodilation, shock, and death.[2]

Other bacteria are opportunistic pathogens and cause disease mainly in people suffering from immunosuppression or cystic fibrosis Examples of these opportunistic pathogens include Pseudomonas aeruginosa, Burkholderia cenocepacia, and Mycobacterium avium.[3][4]

Intracellular

Obligate intracellular parasites (e.g. Chlamydophila, Ehrlichia, Rickettsia) have the ability to only grow and replicate inside other cells. Even these intracellular infections may be asymptomatic, requiring an incubation period. An example of this Rickettsia which causes typhus. Another causes Rocky Mountain spotted fever.

Chlamydia is a phylum of intracellular parasites. These pathogens can cause pneumonia or urinary tract infection and may be involved in coronary heart disease.[5]

Other groups of intracellular bacterial pathogens include: Salmonella, Neisseria, Brucella, Mycobacterium, Nocardia, Listeria, Francisella, Legionella, and Yersinia pestis. These can exist intracellularly, but can exist outside of host cells.

Infections in specific tissue

Bacterial pathogens often cause infection in specific areas of the body. Others are generalists.

Mechanisms

Nutrients

Iron is required for humans, as well as the growth of most bacteria. To obtain free iron, some pathogens secrete proteins called siderophores, which take the iron away from iron-transport proteins by binding to the iron even more tightly. Once the iron-siderophore complex is formed, it is taken up by siderophore receptors on the bacterial surface and then that iron is brought into the bacterium.[14]

Direct damage

Once pathogens attach to host cells, they can cause direct damage as the pathogens use the host cell for nutrients and produce waste products. As pathogens multiply and divide inside host cells, the cells usually rupture and the intercellular bacteria are released. Some bacteria such as E. coli, Shigella, Salmonella, and Neisseria gonorrhoeae, can induce host epithelial cells to engulf them in a process resembling phagocytosis. The pathogens can then disrupt host cells as they pass through them and be extruded from host cells by a reverse phagocytosis process, enabling them to enter other host cells. Some bacteria can also penetrate host cells by excreting enzymes and by their own motility; such penetration can itself damage the host cell.[14]

Toxin production

Toxins are poisonous substances that are produced by certain microorganisms and are often the primary factor contributing to the pathogenic properties of the microorganisms. Endotoxins are the lipid portions of lipopolysaccharides that are part of the outer membrane of the cell wall of gram negative bacteria. Endotoxins are released when the bacteria lyses, which is why after antibiotic treatment symptoms can at first worsen as the bacteria are killed and they release their endotoxins. Exotoxins are proteins produced inside pathogenic bacteria as part of their growth and metabolism, most common in gram positive bacteria. The exotoxins are released when the bacteria die and the cell wall breaks apart. Exotoxins are highly specific in the effects on body tissues and work by destroying particular parts of the host cell or by inhibiting certain metabolic functions. Exotoxins are among the most lethal known substances, only 1 mg of the botulinum exotoxin is enough to kill one million guinea pigs. Diseases caused this way are often caused by minute amounts of exotoxins, not by the bacteria themselves.[14]

Treatment

<templatestyles src="Module:Hatnote/styles.css"></templatestyles>

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, so they exhibit selective toxicity.[15] 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.[16] Phage therapy can also be used to treat certain bacterial infections.[17] 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 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. Bacteria in food are killed by cooking to temperatures above 73 °C (163 °F).

List of genera of pathogenic bacteria and microscopy features

Many genera contain pathogenic bacteria species. They often possess characteristics that help to classify and organize them into groups. The following is a partial listing.

Genus Species Gram staining Shape Oxygen requirement Intra/Extracellular
Bacillus[18] Positive Rods Facultative anaerobic Extracellular
Bartonella[18] Negative Rods Aerobic Facultative intracellular
Bordetella[18] Negative Small coccobacilli Aerobic Extracellular
Borrelia[18] Negative, stains poorly spirochete Anaerobic Extracellular
Brucella[18] Negative coccobacilli Aerobic Intracellular
Campylobacter[18] Negative Spirochete
Bacillus		 microaerophilic extracellular
Chlamydia and Chlamydophila[18] (not Gram-stained) Small, round, ovoid Facultative or strictly aerobic Obligate intracellular
Clostridium[18] Positive Large, blunt-ended rods Obligate anaerobic extracellular
Corynebacterium[18] Positive (unevenly) bacilli Mostly facultative anaerobic extracellular
Enterococcus[20][23] Positive Cocci Facultative Anaerobic extracellular
Escherichia[1][20][24] Negative Bacillus Facultative anaerobic extracellular or intracellular
Francisella[18] Negative coccobacillus strictly aerobic Facultative intracellular
Haemophilus Negative coccobacilli to long and slender filaments extracellular
Helicobacter Negative Spirochete Microaerophile extracellular
Legionella[18] Negative, stains poorly cocobacilli aerobic facultative intracellular
Leptospira[20][27] Negative, stains poorly Spirochete Strictly aerobic extracellular
Listeria[18] Positive, darkly Slender, short rods Facultative Anaerobic intracellular
Mycobacterium[18] (none) Long, slender rods aerobic extracellular
Mycoplasma[18] (none) 'fried egg' appearance, no cell wall Mostly facultative anaerobic; M. pneumoniae strictly aerobic extracellular
Neisseria[20][28] Negative Kidney bean-shaped aerobic Gonococcus: facultative intracellular
N. meningitidis: extracellular
Pseudomonas[20][29] Negative rods Obligate aerobic extracellular
Rickettsia[18] Negative, stains poorly Small, rod-like coccobacillary Aerobic Obligate intracellular
Salmonella[18] Negative Bacillus shape Facultative anaerobica Facultative intracellular
Shigella[20][30] Negative rods Facultative anaerobic extracellular
Staphylococcus[1] Positive, darkly Round cocci Facultative anaerobic extracellular, facultative intracellular
Streptococcus[18] Positive ovoid to spherical Facultative anaerobic extracellular
Treponema[18] Negative, stains poorly Spirochete Aerobic extracellular
Ureaplasma[1] Stains poorly[31] indistinct, 'fried egg' appearance, no cell wall anaerobic extracellular
Vibrio[20][20][32] Negative Spiral with single polar flagellum Facultative anaerobic extracellular
Yersinia[20][33] Negative, bipolarly Small rods Facultative Anaerobe Intracellular

List of species of pathogenic bacteria and clinical characteristics

This is description of the more common genera and species presented with their clinical characteristics and treatments.

Species of human pathogenic bacteria
Species Transmission Diseases Treatment Prevention
Actinomyces israelii Oral flora[34] Actinomycosis:[34] painful abscesses in the mouth, lungs,[35][36] or gastrointestinal tract.[21] Prolonged penicillin G and drainage[34]
Bacillus anthracis

Contact with cattle, sheep, goats and horses[37]
Spores enter through inhalation or through abrasions[20]

Anthrax: pulmonary, gastrointestinal and/or cutaneous symptoms.[34]

 In early infection:[38]

Penicillin
Doxycycline
Ciprofloxacin
Raxibacumab[39]

Anthrax vaccine[20]
Autoclaving of equipment[20]
Bacteroides fragilis Gut flora[34] Abscesses in gastrointestinal tract, pelvic cavity and lungs[34] metronidazole[34] Wound care[40]

Aspiration prevention[40]
Bordetella pertussis

Contact with respiratory droplets expelled by infected human hosts.[20]

Whooping cough[20][34]
Secondary bacterial pneumonia[20]

 Macrolides[20] such as erythromycin,[20][34] before paroxysmal stage[34]

Pertussis vaccine,[20][34] such as in DPT vaccine[20][34]
Borrelia B. burgdorferi[20][34]

B. garinii[20]
B. afzelii[20]

Ixodes ticks
reservoir in deer and mice[20][34]

Early stages of Lyme disease:[20]

Chronic Lyme disease:

Relapsing fever:

Wearing clothing that limits skin exposure to ticks.[20]
Insect repellent.[20]
Avoid areas where ticks are found.[20]
Brucella B. abortus

B. canis
B. melitensis
B. suis

Direct contact with infected animal[20]
Oral, by ingestion of unpasteurized milk or milk products[20]

Brucellosis

doxycycline[20]
streptomycin
or gentamicin[20]
Campylobacter jejuni

Fecal-oral from animals (mammals and fowl)[20][34]
Uncooked meat (especially poultry)[20][34]
Contaminated water[20]

Treat symptoms[20]
Fluoroquinolone[34] such as ciprofloxacin[20] in severe cases[20]

Good hygiene[20]
Avoiding contaminated water[20]
Pasteurizing milk and milk products[20]
Cooking meat (especially poultry)[20]
Chlamydia C. pneumoniae

Respiratory droplets[20][34]

 Atypical pneumonia[34]

Doxycycline[20][34]
Erythromycin[20][34]

 None[20]
C. trachomatis

vaginal sex[20]
oral sex[20]
anal sex[20] Vertical from mother to newborn(ICN)[20]
Direct or contaminated surfaces and flies (trachoma)[20]

Trachoma[20][34]
Neonatal conjunctivitis[20][34]
Neonatal pneumonia[20][34]
Nongonococcal urethritis (NGU)[20][34]
Urethritis[20][34]
Pelvic inflammatory disease[20][34]
Epididymitis[20][34]
Prostatitis[20][34]
Lymphogranuloma venereum (LGV)[20][34]

Erythromycin[20][34]
(adults)[34] Doxycycline[20][34]
(infants and pregnant women)[34]

Erythromycin or silver nitrate in newborn's eyes[20]
Safe sex[20]
Abstinence[20]
Chlamydophila psittaci Inhalation of dust with secretions or feces from birds (e.g. parrots) Psittacosis

Tetracycline[20]
Doxycycline[20]
Erythromycin[20]

 -
Clostridium C. botulinum Spores from soil,[20][34] persevere in canned food, smoked fish and honey[34]

Botulism: Mainly muscle weakness and paralysis[34]

Antitoxin[20][34]
Penicillin[34]
Hyperbaric oxygen[34]
Mechanical ventilation[34]

Proper food preservation techniques
C. difficile

Gut flora,[20][34] overgrowing when other flora is depleted[20]

Pseudomembranous colitis[20][34]

Discontinuing responsible antibiotic[20][34]
Vancomycin or metronidazole if severe[20][34]

 Fecal bacteriotherapy
C. perfringens

Spores in soil[20][34]
Vaginal flora and gut flora[20]

Anaerobic cellulitis[20][34]
Gas gangrene[20][34] Acute food poisoning[20][34]

 Gas gangrene:

Debridement or amputation[20][34]
Hyperbaric medicine[20][34]
High doses of doxycycline[20] or penicillin G[20][34] and clindamycin[34]
Food poisoning: Supportive care is sufficient[20]

 Appropriate food handling[20]
C. tetani

Spores in soil, skin penetration through wounds[20][34]

Tetanus[20]

Tetanus immune globulin[20][34] Sedatives[20]
Muscle relaxants[20]
Mechanical ventilation[20][34]
Penicillin or metronidazole[34]

Tetanus vaccine (such as in the DPT vaccine)[20]
Corynebacterium diptheriae

respiratory droplets
part of human flora

Diphtheria

Horse serum antitoxin
Erythromycin
Penicillin

DPT vaccine
Ehrlichia E. canis[34]

E. chaffeensis[34]

 Dog tick[34] Ehrlichiosis[34]
Enterococcus E. faecalis

E. faecium

Part of gut flora,[34] opportunistic or entering through GI tract or urinary system wounds[20]

bacterial endocarditis[34] biliary tract infections[34] urinary tract infections[34]

Ampicillin (combined with aminoglycoside in endocarditis)[34] Vancomycin[20]

No vaccine Hand washing and other nosocomial prevention
Escherichia E. coli (generally) UTI:[20]

(resistance-tests are required first)

Meningitis:[20]

Diarrhea:[20]

  • Antibiotics above shorten duration
  • Electrolyte and fluid replacement
 (no vaccine or preventive drug)[20]
Enterotoxigenic E. coli (ETEC)
Enteropathogenic E. coli
  • Diarrhea in infants[20]
Enteroinvasive E.coli (EIEC)
Enterohemorrhagic (EHEC), including E. coli O157:H7
  • Reservoir in cattle[20]
Francisella tularensis
  • vector-borne by arthropods[20]
  • Infected wild or domestic animals, birds or house pets[20]
 Tularemia: Fever, ulceration at entry site and/or lymphadenopathy.[42] Can cause severe pneumonia.[42]
  • Avoiding insect vectors[20]
  • Precautions when handling wild animals or animal products[20]
Haemophilus influenzae
  • Droplet contact[20]
  • Human flora of e.g. upper respiratory tract[20]
 Meningitis:[20]

(resistance-tests are required first)
Helicobacter pylori
  • Colonizing stomach[20]
  • Unclear person-to-person transmission[20]
 (No vaccine or preventive drug)[20]
Klebsiella pneumoniae
Legionella pneumophila (no vaccine or preventive drug)[20]

Heating water[20]
Leptospira species
  • Food and water contaminated by urine from infected wild or domestic animals. Leptospira survives for weeks in fresh water and moist soil.[20]
 Vaccine not widely used[20]

Prevention of exposure[20]
Listeria monocytogenes
(no vaccine)[20]
  • Proper food preparation and handling[20]
Mycobacterium M. leprae
  • Prolonged human-human contact, e.g. through exudates from skin lesions to abrasion of other person[20]
 Tuberculoid form:

Lepromatous form:
M. tuberculosis
  • Droplet contact[20]

(difficult, see Tuberculosis treatment for more details)[20]

Standard "short" course:[20]
Mycoplasma pneumoniae
Neisseria N. gonorrhoeae
Uncomplicated gonorrhea:[20]

Ophthalmia neonatorum:

 (No vaccine)[20]
N. meningitidis
Pseudomonas aeruginosa Opportunistic;[34] Infects damaged tissues or people with immunodeficiency.[20] Pseudomonas infection:[20] (no vaccine)[20]
Nocardia asteroides In soil[34] Nocardiosis[34] TMP/SMX[34]
Rickettsia rickettsii (no preventive drug or approved vaccine)[20]
Salmonella S typhi
Other Salmonella species


e.g. S. typhimurium[20]
  • Fecal-oral[20]
  • Food contaminated by fowl[20] (e.g. uncooked eggs)[34] or turtles[34]
(No vaccine or preventive drug)[20]
  • Proper sewage disposal[20]
  • Food preparation[20]
  • Good personal hygiene[20]
Shigella S. sonnei[20]


S. dysenteriae[34]
  • Protection of water and food supplies[20]
  • Vaccines are in trial stage[45]
Staphylococcus aureus Coagulase-positive staphylococcal infections: (no vaccine or preventive drug)
  • Barrier precautions, washing hands and fomite disinfection in hospitals
epidermidis Human flora in skin,[20][34] anterior nares[20] and mucous membranes[34] None[20]
saprophyticus Part of normal vaginal flora[20] None[20]
Streptococcus agalactiae Human flora in vagina,[20][34] urethral mucous membranes,[20] rectum[20] None[20]
pneumoniae
  • 23-serotype vaccine for adults (PPV)[20][34]
  • Heptavalent conjugated vaccine for children (PCV)[20]
pyogenes No vaccine[20]
  • Rapid antibiotic treatment helps prevent rheumatic fever[20]
viridans Oral flora,[34] penetration through abrasions Penicillin G[34]
Treponema pallidum No preventive drug or vaccine[20]
  • Safe sex[20]
  • Antibiotics to pregnant women if risk of transmitting to child[20]
Vibrio cholerae
Yersinia pestis Plague:

See also

References

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External links

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  2. ↑ Lua error in package.lua at line 80: module 'strict' not found.
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  7. ↑ Lua error in package.lua at line 80: module 'strict' not found.
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  10. ↑ Lua error in package.lua at line 80: module 'strict' not found. Page last reviewed: 17/07/2014
  11. ↑ Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson; & Mitchell, Richard N. (2007). Robbins Basic Pathology (8th ed.). Saunders Elsevier. pp. 843 ISBN 978-1-4160-2973-1
  12. ↑ "erysipelas" at Dorland's Medical Dictionary
  13. ↑ "cellulitis" at Dorland's Medical Dictionary
  14. ↑ 14.0 14.1 14.2 Lua error in package.lua at line 80: module 'strict' not found.
  15. ↑ Lua error in package.lua at line 80: module 'strict' not found.
  16. ↑ Lua error in package.lua at line 80: module 'strict' not found.
  17. ↑ Lua error in package.lua at line 80: module 'strict' not found.
  18. ↑ 18.00 18.01 18.02 18.03 18.04 18.05 18.06 18.07 18.08 18.09 18.10 18.11 18.12 18.13 18.14 18.15 18.16 18.17 Unless else specified in boxes then ref is: Lua error in package.lua at line 80: module 'strict' not found.
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  20. ↑ 20.000 20.001 20.002 20.003 20.004 20.005 20.006 20.007 20.008 20.009 20.010 20.011 20.012 20.013 20.014 20.015 20.016 20.017 20.018 20.019 20.020 20.021 20.022 20.023 20.024 20.025 20.026 20.027 20.028 20.029 20.030 20.031 20.032 20.033 20.034 20.035 20.036 20.037 20.038 20.039 20.040 20.041 20.042 20.043 20.044 20.045 20.046 20.047 20.048 20.049 20.050 20.051 20.052 20.053 20.054 20.055 20.056 20.057 20.058 20.059 20.060 20.061 20.062 20.063 20.064 20.065 20.066 20.067 20.068 20.069 20.070 20.071 20.072 20.073 20.074 20.075 20.076 20.077 20.078 20.079 20.080 20.081 20.082 20.083 20.084 20.085 20.086 20.087 20.088 20.089 20.090 20.091 20.092 20.093 20.094 20.095 20.096 20.097 20.098 20.099 20.100 20.101 20.102 20.103 20.104 20.105 20.106 20.107 20.108 20.109 20.110 20.111 20.112 20.113 20.114 20.115 20.116 20.117 20.118 20.119 20.120 20.121 20.122 20.123 20.124 20.125 20.126 20.127 20.128 20.129 20.130 20.131 20.132 20.133 20.134 20.135 20.136 20.137 20.138 20.139 20.140 20.141 20.142 20.143 20.144 20.145 20.146 20.147 20.148 20.149 20.150 20.151 20.152 20.153 20.154 20.155 20.156 20.157 20.158 20.159 20.160 20.161 20.162 20.163 20.164 20.165 20.166 20.167 20.168 20.169 20.170 20.171 20.172 20.173 20.174 20.175 20.176 20.177 20.178 20.179 20.180 20.181 20.182 20.183 20.184 20.185 20.186 20.187 20.188 20.189 20.190 20.191 20.192 20.193 20.194 20.195 20.196 20.197 20.198 20.199 20.200 20.201 20.202 20.203 20.204 20.205 20.206 20.207 20.208 20.209 20.210 20.211 20.212 20.213 20.214 20.215 20.216 20.217 20.218 20.219 20.220 20.221 20.222 20.223 20.224 20.225 20.226 20.227 20.228 20.229 20.230 20.231 20.232 20.233 20.234 20.235 20.236 20.237 20.238 20.239 20.240 20.241 20.242 20.243 20.244 20.245 20.246 20.247 20.248 20.249 20.250 20.251 20.252 20.253 20.254 20.255 20.256 20.257 20.258 20.259 20.260 20.261 20.262 20.263 20.264 20.265 20.266 20.267 20.268 20.269 20.270 20.271 20.272 20.273 20.274 20.275 20.276 20.277 20.278 20.279 20.280 20.281 20.282 20.283 20.284 20.285 20.286 20.287 20.288 20.289 20.290 20.291 20.292 20.293 20.294 20.295 20.296 20.297 20.298 20.299 20.300 20.301 20.302 20.303 20.304 20.305 20.306 20.307 20.308 20.309 20.310 20.311 20.312 Lua error in package.lua at line 80: module 'strict' not found.
  21. ↑ 21.0 21.1 Lua error in package.lua at line 80: module 'strict' not found.
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  29. ↑ Lua error in package.lua at line 80: module 'strict' not found. Created: 30 September 2005. Last update: 01 April 2013
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  32. ↑ Lua error in package.lua at line 80: module 'strict' not found.
  33. ↑ Lua error in package.lua at line 80: module 'strict' not found.
  34. ↑ 34.000 34.001 34.002 34.003 34.004 34.005 34.006 34.007 34.008 34.009 34.010 34.011 34.012 34.013 34.014 34.015 34.016 34.017 34.018 34.019 34.020 34.021 34.022 34.023 34.024 34.025 34.026 34.027 34.028 34.029 34.030 34.031 34.032 34.033 34.034 34.035 34.036 34.037 34.038 34.039 34.040 34.041 34.042 34.043 34.044 34.045 34.046 34.047 34.048 34.049 34.050 34.051 34.052 34.053 34.054 34.055 34.056 34.057 34.058 34.059 34.060 34.061 34.062 34.063 34.064 34.065 34.066 34.067 34.068 34.069 34.070 34.071 34.072 34.073 34.074 34.075 34.076 34.077 34.078 34.079 34.080 34.081 34.082 34.083 34.084 34.085 34.086 34.087 34.088 34.089 34.090 34.091 34.092 34.093 34.094 34.095 34.096 34.097 34.098 34.099 34.100 34.101 34.102 34.103 34.104 34.105 34.106 34.107 34.108 34.109 34.110 34.111 34.112 34.113 34.114 34.115 34.116 34.117 34.118 34.119 34.120 34.121 34.122 34.123 34.124 34.125 34.126 34.127 34.128 34.129 34.130 34.131 34.132 34.133 34.134 34.135 34.136 34.137 34.138 34.139 34.140 34.141 34.142 34.143 34.144 34.145 34.146 34.147 34.148 34.149 34.150 34.151 34.152 34.153 34.154 34.155 34.156 34.157 34.158 34.159 34.160 34.161 34.162 34.163 34.164 34.165 34.166 34.167 34.168 34.169 34.170 34.171 34.172 34.173 34.174 34.175 34.176 34.177 34.178 34.179 34.180 34.181 34.182 34.183 34.184 34.185 34.186 34.187 34.188 34.189 34.190 34.191 34.192 34.193 34.194 34.195 34.196 34.197 34.198 34.199 34.200 34.201 34.202 34.203 34.204 34.205 34.206 34.207 34.208 34.209 34.210 34.211 34.212 34.213 34.214 34.215 34.216 34.217 34.218 34.219 34.220 34.221 Lua error in package.lua at line 80: module 'strict' not found.
  35. ↑ Lua error in package.lua at line 80: module 'strict' not found.
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  37. ↑ Lua error in package.lua at line 80: module 'strict' not found.
  38. ↑ Lua error in package.lua at line 80: module 'strict' not found.
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  44. ↑ Lua error in package.lua at line 80: module 'strict' not found. Page last reviewed: November 24, 2010. Page last updated: August 27, 2012
  45. ↑ 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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