Chapter 19 : Gram-Positive Uropathogens, Polymicrobial Urinary Tract Infection, and the Emerging Microbiota of the Urinary Tract

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Uncomplicated urinary-tract infection (UTI) is most common in young, sexually active, nonpregnant, premenopausal women. Gram-negative bacteria are isolated from 75% to 95% of these infections ( ). The remaining proportions of uncomplicated UTI are associated with a variety of organisms, including the Gram-positive bacteria , , (group B , GBS), and other less frequently isolated organisms. In demographic groups such as pregnant women and the elderly, Gram-positive bacteria are found more often as etiologic agents of UTI. Symptoms associated with uncomplicated UTI caused by Gram-positive uropathogens are similar to those caused by Gram-negative organisms and usually include dysuria, urinary frequency, urinary urgency, and/or suprapubic pain. Fever, chills, costovertebral-angle tenderness, flank pain, and/or nausea are suggestive of upper urinary tract (kidney) involvement.

Citation: Kline K, Lewis A. 2017. Gram-Positive Uropathogens, Polymicrobial Urinary Tract Infection, and the Emerging Microbiota of the Urinary Tract, p 459-502. In Mulvey M, Klumpp D, Stapleton A (ed), Urinary Tract Infections: Molecular Pathogenesis and Clinical Management, Second Edition. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.UTI-0012-2012
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Figure 1

virulence factors. Secreted surface proteins: Aas, possesses N-terminal signal sequence, but no motifs such as a transmembrane domain, LPXTG sortase-recognition motif, or proline/glycine-rich cell wall-spanning domain to indicate the mode of attachment to the cell surface after translocation across the membrane (indicated by the purple question marks) ( ). Immuno-electron microscopy shows Aas as part of a fuzzy surface layer that is absent when Aas is not expressed ( ). Ssp has a YSIRK-containing signal sequence but no sortase-recognition motif so its mode of attachment to the cell surface is uncertain (indicated by the red question mark); it is easily sheared from the cell surface. Electron microscopy and immuno-electron micrographs also show Ssp to exist as part of fuzzy surface layer, apparently consisting of 50–75nm fibrillar structures; the nature of these fibers in not known ( ). UafA, SdrI, SssF, and UafB contain an LPXTG motif and are predicted to be covalently attached to the cell wall ( ). The small arrows near the membrane-anchored sortase enzymes indicate the two-step transpeptidation reaction whereby sortase substrates are first cleaved within the LPXTG motif to create a sortase-substrate intermediate (and releasing the membrane domain and positively charged cytoplasmic tail, indicated by the straight line in the membrane) that is then resolved, resulting in covalent linkage of the substrate to the cell wall ( ). UafB is genetically linked to accessory secretion genes and that are predicted to encode a dedicated accessory secretion system for UafB ( ). Cytoplasmic enzymes that promote survival in urine ( ).

Citation: Kline K, Lewis A. 2017. Gram-Positive Uropathogens, Polymicrobial Urinary Tract Infection, and the Emerging Microbiota of the Urinary Tract, p 459-502. In Mulvey M, Klumpp D, Stapleton A (ed), Urinary Tract Infections: Molecular Pathogenesis and Clinical Management, Second Edition. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.UTI-0012-2012
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Figure 2

Gram-positive inhabitants and pathogens of the human urinary tract. Approximate phylogenetic relationships between Gram-positive bacteria are illustrated in this schematic representation. Please refer to the text and Table 1 for additional information and references describing these genera as uropathogens or inhabitants of the human urinary tract. On the left, and belong to the order which together with the orders belong to the class (a.k.a. “high-GC Gram-positive bacteria”). belongs to the order and the class . The classes and both belong to the phylum . The remaining genera, with the exception of belong to the phylum . Whereas , , and belong to the order and the class , and belong to the order and the class . Members of the order (, , , and ), are also classified as . The genus is also a member of the , but belongs to the class and order and respectively. On the other hand, belongs to the phylum , the class and the order .

Citation: Kline K, Lewis A. 2017. Gram-Positive Uropathogens, Polymicrobial Urinary Tract Infection, and the Emerging Microbiota of the Urinary Tract, p 459-502. In Mulvey M, Klumpp D, Stapleton A (ed), Urinary Tract Infections: Molecular Pathogenesis and Clinical Management, Second Edition. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.UTI-0012-2012
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Figure 3

Transmission-electron micrographs of several urogenital isolates from the phylum . Strains grown for 24–48 hours underwent negative staining with uranyl acetate and were examined by TEM. These strains were isolated from the urine or vaginas of pregnant or nonpregnant women and are available through BEI resources. Strain names are as follows: MJR8396A; CMW7705A; CMW7778A; MJR8628B; , MJR7694. Scale bars are 500 nm. Shaded backgrounds contain images of the same strain.

Citation: Kline K, Lewis A. 2017. Gram-Positive Uropathogens, Polymicrobial Urinary Tract Infection, and the Emerging Microbiota of the Urinary Tract, p 459-502. In Mulvey M, Klumpp D, Stapleton A (ed), Urinary Tract Infections: Molecular Pathogenesis and Clinical Management, Second Edition. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.UTI-0012-2012
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