PSEUDOMONAS AERUGINOSA

Overview

Commonly referred to as P.aeruginosa, Pseudomonas aeriginosa is an infection-causing bacteria

that primarily affects the lungs (Pneumonia) and blood. It is a harmful germ that specifically
affects individuals with weakened immune systems and underlying health conditions. Infections
caused by Pseudomonas aeruginosa are particularly difficult to treat due to their increasing
resistance to antibiotics and other treatments.

History

This ubiquitous organism was first discovered and identified in 1882, by Carle Gessard, a Dutch
microbiologist who was able to successfully isolate and culture the bacteria. Gessard carefully
isolated the bacterium from water sources and initially named it “Bacillus Aeruginosa”, as it
imparted a blue-green pigment, namely pyocyanine, to infected tissues, wounds and
secretions. After studying the cutaneous wounds of two patients lol that's kind of weird. He later
reported his findings in a report titled “

During the rest of the 19th century, several other reports also indicated Pseudomonas
aeruginosa to be a causative agent that induced blue-green purulence within injured soldiers
and other patients.

Since its first discovery in 1882, P. aeruginosa and its resistance mechanisms, virulence factors
and its ability to produce biofilms have been investigated thoroughly by scientists all over the
world. It continues to be at the forefront of microbiology research aimed at diagnosis,
prevention and treatment of infections caused by it.
Epidemiology

Pseudomonas aeruginosa is capable of surviving in diverse environments. These include soil,

water bodies and vegetation. They can also be found in hospital sinks, food and respiratory
equipment.

Morphology

Pseudomonas aeruginosa is a gram-negative, rod-shaped bacteria which is typically 1-3

micrometres long. It is gram-negative, meaning that it consists of a thin layer of peptidoglycan
cell wall that is sandwiched between the outer lipid membrane and the inner cytoplasmic
membrane. As bacteria are stained using the Gram Staining Technique, this feature allows the
bacteria to turn pink/red when stained. This is because the outer lipid membrane prevents the
retention of the crystal violet dye used in the staining process. Without the outer lipid
membrane, the bacteria would stain blue/purple and would be classified as gram-positive.

It is a mono-flagellated bacterium (consists of a single flagellum for motility).

Metabolism

Pseudomonas aeruginosa is a bacteria that mainly respires aerobically but is also capable of
switching to fermentation in the absence of oxygen, hence, it classifies as a facultative anaerobe.
It can make use of various organic and inorganic substances as sources of carbon and energy due
to its highly efficient respiratory system.

As mentioned before, P. aeruginosa is a versatile bacteria that can utilize multiple nutrients for
metabolic processes. These include carbon, nitrogen and iron.

The bacteria can use multiple sources of carbon for growth, be it sugars (fructose, glucose)
amino acids and fatty acids. Various catabolic pathways such as glycolysis and the pent
phosphate pathway allow P. aeruginosa to create energy and metabolize different carbon sources

The bacteria perform protein synthesis using sources of nitrogen such as ammonium, amino
acids and urea. Phenomena such as nitrogen assimilation and amino acid biosynthesis can take
place due to it consisting of enzymes that are involved in nitrogen assimilation pathways.

P. aeruginosa also requires iron to grow and reproduce. However, iron is significantly more
difficult to acquire than carbon and nitrogen, as it is taken from host environments that have
mechanisms to keep iron limited. The bacteria hence produce siderophores, which are molecules
that strongly bind to iron molecules (small, high-affinity iron-chelating molecules), allowing the
bacteria to grab iron from host proteins or nearby surroundings.

Quorum Sensing and Secondary Metabolism; Pseudomonas aeruginosa uses quorum sensing, a
communication system, between cells to control the activation of traits the formation of biofilms
and the production of chemicals based on the density of its population. Some examples of these
chemicals produced by P. Aeruginosa include pyocyanin (a blue-green pigment), pyoverdine (a
fluorescent siderophore), and quorum-sensing signalling molecules (e.g., N-acyl homoserine
lactones) These substances play roles in causing diseases, communication between species and
interactions, within ecosystems.

P. Aeruginosa is skilled, at creating biofilms which are organized groups of cells surrounded by a
matrix on both living and living surfaces. The process of biofilm formation includes metabolic
activities such as generating polymeric substances sticking to surfaces and regulating gene
expression within the biofilm community. These biofilms aid P. Aeruginosa in surviving in host
settings resisting treatments and causing lasting infections.

Antibiotic resistance

Cultures and strains of P. aeruginosa seem to have complex and intrinsic resistance mechanisms
that make them multi-drug resistant (resistant to nearly all antibiotics), including carbapenems.
Hence, it is very difficult to eliminate and cure.

Additionally, scientists have recently discovered that it utilises a rather smart way of resisting
antibiotics, known as adaptive antibiotic resistance.
One way P. aeruginosa resists antibiotics is by producing a layer of biofilm- a slimy, protective
layer that forms over the culture of bacteria. This layer makes it harder for the antibiotics to
reach the bacteria, hence increasing its resistance.

P. aeruginosa also produces persistor cells. These cells can survive even in the presence of
antibiotics. They hide away and reappear in the absence of antibiotics. This can cause
recalcitrance and relapse.

Associated Infections

Pseudomonas aeruginosa is the leading cause of death in hospitalised patients with underlying
conditions and weak immune systems. Specifically, infection is prevalent among patients with
burn wounds, cystic fibrosis, intravenous drug addictions and acute leukaemia. As this bacteria
is ubiquitous and thrives in hospital environments, patients are frequently infected by it, causing
relapses. Those at immediate risk include young children below the age of 2 and older
hospitalised patients over the age of 65.

This bacteria can cause infections in various parts of the body. These include the respiratory
tract, urinary tract, ears, bloodstream, and skin and soft tissues.

1) Pneumonia
Pseudomonas aeruginosa can cause pneumonia, a condition in which the alveoli inflame
and swell up with fluid/pus, making it difficult for oxygen to reach the bloodstream.
Some common symptoms of pneumonia include fever, a chronic cough that produces
phlegm, and chest pain.

2) Otitis externa
Also referred to as ‘Swimmer’s ear” Otitis externa is an infection that affects the external
auditory canal (EAC) and/or the auricle of the ear. As mentioned before, P. aeruginosa
can be found in various water surroundings, such as lakes, swimming pools and rivers.
 When exposed to these environments, individuals can get infected by P. aeruginosa if it
enters the ear as the warm conditions support the growth and survival of the bacteria.
Infected individuals experience swelling and redness in their ears, and even ear
discharge.

3) Folliculitis
P. aeruginosa can also cause folliculitis, a condition where cutaneous hair follicles on the
skin get infected. It is reported to develop after exposure to contaminated water
environments such as pools and lakes and after waxing body hair. Small, pimple-like
lesions and growths begin to grow in the exposed areas, and can sometimes be painful.

4) Endophthalmitis
Endophthalmitis is the condition of inflammation in the tissues or fluid inside the
eyeball, which often causes irreversible vision loss. Eyeball tissue can be infected
following ocular trauma or invasive eye surgery, such as cataract surgery or intravitreal
injections. Furthermore, improper contact lens hygiene/extended periods of wearing can
increase the risks of Pseudomonas aeruginosa-induced endophthalmitis.

5) Meningitis
Inflammation around the brain and spinal cord can lead to meningitis. It is a fatal
infection that requires immediate medical attention. Individuals can acquire this
infection through the intake of contaminated water/food. The initial symptoms of this
infection typically start with fevers and headaches, however, can escalate quickly.

Virulence factors

Pathogenicity refers to how easily pathogens can cause and spread diseases within host
organisms. Virulence factors, on the other hand, refer to factors produced by pathogens that
contribute to the pathogenicity of the pathogen. Pseudomonas aeruginosa equips itself with
various virulence factors that help cause and propagate the disease throughout the host
organism. These include exotoxins, endotoxins, proteases, elastases and biofilm formation.

1) Exotoxins
Exotoxins refer to proteins produced by bacteria that help disrupt and evade the immune
system by destroying cells. Exotoxins can cause inflammation, hot cell lysis and tissue
damage

2) Endotoxins
Even though P. aeruginosa is a gram-negative bacteria that does not generally produce
endotoxins, it still possesses lipopolysaccharide (LPS) molecules in its outer membrane.
These LPS molecules can elicit a strong immune response in the host, leading to
inflammation and tissue damage, particularly when released in large quantities during
infection.

3) Proteases
P. aeruginosa produces protease enzymes which help break down the proteins present in
the cells of the host organism. This helps the bacteria to increase its survival rate by
targeting immune system proteins such as cytokines and antibodies which are vital for
defence. As cytokines and antibodies are attacked, the immune system is impaired,
allowing the bacteria the freely thrive within the host organism.

Biofilm formation performed by cultures of Pseudomonas aeruginosa can also be classified as a

virulence factor, as it increases the survivability of the bacteria by making it multi-drug
resistant.

In conclusion, P. aeruginosa’s capability to flourish in diverse environments, be multi-drug

resistant, and cause significantly dangerous infections emphasizes the need for continual
innovation and research aimed at finding effective treatments and preventing the further spread
of infection.
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