Enterococcus faecalis


Enterococcus faecalis

Description, Causes and Risk Factors:

A bacterial species found in human feces and in the intestines of many warm-blooded animals; occasionally found in urinary infections and in blood and heart lesions in cases of subacute endocarditis.

Enterococcus faecalis

Enterococci are involved in serious infections in humans, although they were classically considered more as a commensal of the gastrointestinal tract of humans and animals rather than a specialized human pathogen. The enterococcal species responsible for most infections both in community and hospital settings is Enterococcus faecalis.

Typically, this bacteria is transferred to water and soil through feces from animals. Preventing transmission generally involves thoroughly washing hands after cleaning pet waste and employing proper hand-washing techniques after using the restroom. Hospitalized patients are especially vulnerable to enterococcus faecalis because of their weakened condition and because the bacteria is known to populate catheters and rectal thermometers.

In a number of cases, Enterococcus faecalis has been believed to be responsible for water contamination issues. Public or open bodies of water in the United States are required to maintain a low level of contamination, some as strict as 7 units per 100mL of water. As of 2004, the Enterococcus genus of bacteria became the new federal standard for determining water quality on the country's public beaches.

Several diseases that can be attributed to Enterococcus faecalis include bacteremia, meningitis, and urinary tract infections. Bacteremia is a general term for a condition in which bacteria is present in the blood stream. Because blood is intended to be sterile, any presence of bacteria can be very damaging and even fatal, especially since transfusion throughout the body can be rather rapid. Sepsis or septic shock can occur as a result of this condition, both of which can be fatal. Meningitis is an infection causing the membranes around the brain and spinal cord to become inflamed and swell. Because of the infections proximity to the brain, meningitis can quickly become life threatening. Urinary tract infections, or UTIs as they are more commonly known, are infections affecting the urinary tract. In humans, they generally cause a frequent need to urinate, pain, and clouded urine. The most common form of UTIs are bladder infections.

Symptoms:

Common symptoms may include:

    Burning pain with urination.

  • Urinary urgency and frequency.

  • Fever and chills.

  • Flank pain.

  • Fatigue and weakness.

  • Nausea and vomiting.

  • Diarrhea.

  • Severe abdominal pain.

  • Chest pain.

  • Shortness of breath.

  • Neurological symptoms.

Diagnosis:

Laboratory testing is required to determine whether Enterococcus faecalis is the cause of any particular infection.The appropriate laboratory studies depend on the potential clinical syndrome present.Obtain cultures from sites suspected to be infected, including blood, urine, peritoneal fluid, joint fluid, CSF, and/or pyogenic fluid collections in soft tissue for analysis.

Imaging:

    A CT scan of the abdomen is indicated if symptoms or signs indicate a renal or gastrointestinal source of infection or if no clear focus of infection is evident elsewhere.

  • Transthoracic echocardiography is often performed as an initial screening test; if endocarditis is strongly suggested and if transthoracic echocardiography findings are negative, transesophageal echocardiography should be performed.

Treatment:

Treatment of E. faecalis consists of a synergistic combination of aminoglycoside and cell wall active antibiotics. In trying to prevent further antibiotic resistant strains, drug susceptibility testing is strongly recommended. New stronger and more specific antibiotics are being developed. Multistage resistance has already been observed in laboratory testing. There are also current studies looking into inactivating cytolysin toxin.

Cytolysin toxin is responsible for rupturing a variety of target membranes and contributes to the toxicity/lethality of the infection. By inactivating the cytolysin, they are hoping to reduce number of this bacterium in circulation, while not harming many of the natural microorganisms in the body. This can be accomplished because of its highly specific targeting. Resistance to this treatment is not likely due to the fact that the organism is not being directly attacked. Since the irreversible damage of antibiotic resistance has already been created, hopefully this new therapy will make great strides in the fight against multiple drug resistant E. faecalis.

NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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