Molecular detection of some virulence factors among Enterococcus species isolated from patients with cystitis


Enterococcal bacteria have emerged as main nosocomial pathogens. Virulence factor is important in enhancing ability to cause disease. Some of which are very significant in the pathogenesis of diseases caused via them. Resistance genes only does not indicate pathogenicity of bacteria, presence them with virulence factors it can cause the strain to be dangerous. Eighty-nine Enterococci were recovered from patient with cystitis. All isolates confirmed by m-EI chromogenic agar and the virulence factors were assayed by conventional PCR. It was found that esp observed in (35.4%) E.fecalis, (30%) E.faecium and (36.7%, 10%) E.faecalis and E.faecium respectively have asa1 gene, (22.7%) E.fecalis give positive result and all E.faecium was free of ace, (8.8%) E.faecalis have cyl gene and all of E. faecium didn’t have this gene, 6.3% of E.faecalis and no one of E.faecium have hyl gene. 16.4% of E.faecalis and 30% have EF3314 gene. virulence factors commonly prevalent in enterococcus isolated in this study, the incidence of virulence factors was higher average number in E.faecalis and much lower average number in E. faecium.


  • Abdeen EE, Hussien H, Hussan Z, Abdella W (2016) Genotyping and virulence genes of Enterococcus faecalis isolated form kareish cheese and minced meat in Egypt. Research Journal of Microbiology 11: 133-138.
  • Abriouel H, Omar NB, Molinos AC, López RL, Grande MJ, et al. (2008) Comparative analysis of genetic diversity and incidence of virulence factors and antibiotic resistance among enterococcal populations from raw fruit and vegetable foods, water and soil, and clinical samples. International journal of food microbiology 123(1-2): 38-49.
  • Bai B, Hu K, Li H, Yao W, Li D, Chen Z, Cheng H, et al. (2018) Effect of tedizolid on clinical Enterococcus isolates: in vitro activity, distribution of virulence factor, resistance genes and multilocus sequence typing. FEMS microbiology letters 365(3): fnx284.
  • Baldassarri L, Creti R, Arciola CR, Montanaro L, Venditti M, Di Rosa R (2004) Analysis of virulence factors in cases of enterococcal endocarditis. Clinical microbiology and infection 10(11): 1006-1008.
  • Barbosa-Ribeiro M, De-Jesus-Soares A, Zaia AA, Ferraz CC, Almeida JF, Gomes BP (2016) Antimicrobial susceptibility and characterization of virulence genes of Enterococcus faecalis isolates from teeth with failure of the endodontic treatment. Journal of endodontics 42(7): 1022-1028.
  • Biswas PP, Dey S, Adhikari L, Sen A (2014) Virulence markers of vancomycin resistant enterococci isolated from infected and colonized patients. Journal of global infectious diseases 6(4): 157.
  • Cha JO, Jung YH, Lee HR, Yoo JI, Lee YS (2012) Comparison of genetic epidemiology of vancomycin-resistant Enterococcus faecium isolates from humans and poultry. Journal of medical microbiology 61(8): 1121-1128.
  • Choi JM, Woo GJ (2013) Molecular characterization of high-level gentamicin-resistant Enterococcus faecalis from chicken meat in Korea. International journal of food microbiology 165(1): 1-6.
  • Chuang-Smith ON, Wells CL, Henry-Stanley MJ, Dunny GM (2010) Acceleration of Enterococcus faecalis biofilm formation by aggregation substance expression in an ex vivo model of cardiac valve colonization. PloS one 5(12).
  • Creti R, Fabretti F, Koch S, Huebner J, Garsin DA, et al. (2009) Surface protein EF3314 contributes to virulence properties of Enterococcus faecalis. The International journal of artificial organs 32(9): 611-620.
  • Creti R, Imperi M, Bertuccini L, Fabretti F, Orefici G, Di Rosa R, Baldassarri L (2004) Survey for virulence determinants among Enterococcus faecalis isolated from different sources. Journal of medical microbiology 53(1): 13-20.
  • Cucarella C, Solano C, Valle J, Amorena B, Lasa Í, Penadés JR (2001) Bap, a Staphylococcus aureus surface protein involved in biofilm formation. Journal of bacteriology 183(9): 2888-2896.
  • Daniel DS, Lee SM, Gan HM, Dykes GA, Rahman S (2017) Genetic diversity of Enterococcus faecalis isolated from environmental, animal and clinical sources in Malaysia. Journal of infection and public health 10(5): 617-623.
  • Duprè I, Zanetti S, Schito AM, Fadda G, Sechi LA (2003) Incidence of virulence determinants in clinical Enterococcus faecium and Enterococcus faecalis isolates collected in Sardinia (Italy). Journal of Medical Microbiology 52(6): 491-498.
  • Elmalı M, Can HY (2018) The prevalence, vancomycin resistance and virulence gene profiles of Enterococcus species recovered from different foods of animal origin. Veterinarski arhiv 88(1): 111-124.
  • Elsner HA, Sobottka I, Mack D, Laufs R, Claussen M, Wirth R (2000) Virulence factors of Enterococcus faecalis and Enterococcus faecium blood culture isolates. European Journal of Clinical Microbiology and Infectious Diseases 19(1): 39-42.
  • Faguy DM (2000) Bacterial genomics: The controlled chaos of shifty pathogens. Current Biology 10(13): R498-501.
  • Hällgren A, Claesson C, Saeedi B, Monstein HJ, Hanberger H, Nilsson LE (2009) Molecular detection of aggregation substance, enterococcal surface protein, and cytolysin genes and in vitro adhesion to urinary catheters of Enterococcus faecalis and E. faecium of clinical origin. International Journal of Medical Microbiology 299(5): 323-332.
  • Han D, Unno T, Jang J, Lim K, Lee SN, Ko G, Sadowsky MJ, Hur HG (2011) The occurrence of virulence traits among high-level aminoglycosides resistant Enterococcus isolates obtained from feces of humans, animals, and birds in South Korea. International journal of food microbiology 144(3): 387-392.
  • Heidari H, Emaneini M, Dabiri H, Jabalameli F (2016) Virulence factors, antimicrobial resistance pattern and molecular analysis of Enterococcal strains isolated from burn patients. Microbial pathogenesis 90: 93-97.
  • Heidari H, Hasanpour S, Ebrahim-Saraie HS, Motamedifar M (2017) High incidence of virulence factors among clinical Enterococcus faecalis isolates in southwestern Iran. Infection & chemotherapy 49(1): 51-56.
  • Hynes WL, Walton SL (2000) Hyaluronidases of Gram-positive bacteria. FEMS microbiology letters 183(2): 201-207.
  • Igbinosa E, Beshiru AT (2019) Antimicrobial resistance, virulence determinants and biofilm formation of Enterococcus species from ready-to-eat seafood. Frontiers in microbiology 10: 728.
  • Javad RIKI, Rezazade MH, Gholamreza MIRI (2016) Urban Park Use, Quality Evaluation, and Resident Satisfaction Indicators in the City of Zahedan, Iran. International Journal of Geography and Geology 5(4): 60-72.
  • Kafil HS, Mobarez AM (2015) Spread of enterococcal surface protein in antibiotic resistant Entero-coccus faecium and Enterococcus faecalis isolates from urinary tract infections. The open microbiology journal 9: 14.
  • Kayaoglu G, Ørstavik D (2004) Virulence factors of Enterococcus faecalis: relationship to endodontic disease. Critical Reviews in Oral Biology & Medicine 15(5): 308-320.
  • Koch S, Hufnagel M, Theilacker C, Huebner J (2004) Enterococcal infections: host response, therapeutic, and prophylactic possibilities. Vaccine 22(7): 822-830.
  • Leavis H, Top J, Shankar N, Borgen K, Bonten M, van Embden J, Willems RJ (2004) A novel putative enterococcal pathogenicity island linked to the esp virulence gene of Enterococcus faecium and associated with epidemicity. Journal of bacteriology 186(3): 672-682.
  • Mohamed JA, Huang DB (2007) Biofilm formation by enterococci. Journal of medical microbiology 56(12): 1581-1588.
  • Mundy LM, Sahm DF, Gilmore M (2000) Relationships between enterococcal virulence and antimicrobial resistance. Clinical microbiology reviews 13(4): 513-522.
  • Nallapareddy SR, Qin X, Weinstock GM, Höök M, Murray BE (2000) Enterococcus faecalis adhesin, ace, mediates attachment to extracellular matrix proteins collagen type IV and laminin as well as collagen type I. Infection and immunity 68(9): 5218-5224.‏
  • Ochoa SA, Escalona G, Cruz-Córdova A, Dávila LB, Saldaña Z, et al. (2013) Molecular analysis and distribution of multidrug-resistant Enterococcus faeciumisolates belonging to clonal complex 17 in a tertiary care center in Mexico City. BMC microbiology 13(1): 291.
  • Poeta P, Costa D, Klibi N, Rodrigues J, Torres C (2006) Phenotypic and Genotypic Study of Gelatinase and β‐Haemolysis Activities in Faecal Enterococci of Poultry in Portugal. Journal of Veterinary Medicine, Series B 53(5): 203-208.
  • Rice LB, Carias L, Rudin S, Vael C, Goossens H, Konstabel C, et al. (2003) A potential virulence gene, hyl Efm, predominates in Enterococcus faecium of clinical origin. The Journal of infectious diseases 187(3): 508-512.
  • Sava IG, Heikens E, Huebner J (2010) Pathogenesis and immunity in enterococcal infections. Clinical microbiology and infection 16(6): 533-540.
  • Semedo T, Santos MA, Martins P, Lopes MF, Marques JJ, Tenreiro R, Crespo MT (2003) Comparative study using type strains and clinical and food isolates to examine hemolytic activity and occurrence of the cyl operon in enterococci. Journal of Clinical Microbiology 41(6): 2569-2576.
  • Seno Y, Kariyama R, Mitsuhata R, Monden K, Kumon H (2005) Clinical implications of biofilm formation by Enterococcus faecalis in the urinary tract. Acta Medica Okayama 59(3): 79-87.
  • Shahraki S, Mousavi MR (2017) Determination of virulence factors in clinical multidrug resistance Enterococci isolates at Southeast of Iran. Jundishapur Journal of Microbiology 10(5).
  • Shankar N, Lockatell CV, Baghdayan AS, Drachenberg C, Gilmore MS, Johnson DE (2001) Role of Enterococcus faecalissurface protein ESP in the pathogenesis of ascending urinary tract infection. Infection and immunity 69(7): 4366-4372.
  • Shankar V, Baghdayan AS, Huycke MM, Lindahl G, Gilmore MS (1999) Infection-derived Enterococcus faecalisstrains are enriched in esp, a gene encoding a novel surface protein. Infection and immunity 67(1): 193-200.
  • Sharifi Y, Hasani A, Ghotaslou R, Naghili B, Aghazadeh M, Milani M, Bazmany A (2013) Virulence and antimicrobial resistance in enterococci isolated from urinary tract infections. Advanced pharmaceutical bulletin 3(1): 197.
  • Sharifi Y, Hasani A, Ghotaslou R, Varshochi M, Hasani A, Aghazadeh M, Milani M (2012) Survey of virulence determinants among vancomycin resistant Enterococcus faecalis and Enterococcus faecium isolated from clinical specimens of hospitalized patients of North west of Iran. The open microbiology journal 6: 34.
  • Shokoohizadeh L, Ekrami A, Labibzadeh M, Ali L, Alavi SM (2018) Antimicrobial resistance patterns and virulence factors of enterococci isolates in hospitalized burn patients. BMC research notes 11(1): 1.
  • Stępień-Pyśniak D, Hauschild T, Kosikowska U, Dec M, Urban-Chmiel R (2019) Biofilm formation capacity and presence of virulence factors among commensal Enterococcus spp. from wild birds. Scientific reports 9(1): 1-7.
  • Toledo-Arana A, Valle J, Solano C, Arrizubieta MJ, Cucarella C, et al. (2001) The enterococcal surface protein, Esp, is involved in Enterococcus faecalis biofilm formation. Appl. Environ. Microbiol. 67(10): 4538-4545.
  • Van Tyne D, Martin MJ, Gilmore MS (2013) Structure, function, and biology of the Enterococcus faecalis cytolysin. Toxins 5(5): 895-911.
  • Vankerckhoven V, Van Autgaerden T, Vael C, Lammens C, Chapelle S, Rossi R, Jabes D, Goossens H (2004) Development of a multiplex PCR for the detection of asa1, gelE, cylA, esp, and hyl genes in enterococci and survey for virulence determinants among European hospital isolates of Enterococcus faecium. Journal of clinical microbiology 42(10): 4473-4479.
  • Vidana R, Rashid MU, Özenci V, Weintraub A, Lund B (2016) The origin of endodontic Enterococcus faecalis explored by comparison of virulence factor patterns and antibiotic resistance to that of isolates from stool samples, blood cultures and food. International endodontic journal 49(4): 343-351.
  • Willems RJ, Homan W, Top J, van Santen-Verheuvel M, Tribe D, et al. (2001) Variant esp gene as a marker of a distinct genetic lineage of vancomycinresistant Enterococcus faecium spreading in hospitals. The Lancet 357(9259): 853-855.
  • Zheng JX, Wu Y, Lin ZW, Pu ZY, Yao WM, Chen Z, Li DY, Deng QW, Qu D, Yu ZJ (2017) Characteristics of and virulence factors associated with biofilm formation in clinical Enterococcus faecalis isolates in China. Frontiers in microbiology 8: 2338.


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