During infection, histological damage is caused by cytotoxins including hemolysin and a variety of proteases, some autotransported. When swarms from different strains meet, a line of demarcation, a “Dienes line”, develops due to the killing action of each strain’s type VI secretion system. mirabilis undergoes a morphological conversion to a filamentous swarmer cell expressing hundreds of flagella. Motility is mediated by flagella encoded on a single contiguous 54 kb chromosomal sequence. Repressors of motility are often encoded by these fimbrial operons. Adherence of the bacterium to epithelial and catheter surfaces is mediated by 17 different fimbriae, most notably MR/P fimbriae. These infections may be accompanied by urolithiasis, development of bladder or kidney stones due to alkalinization of urine from urease-catalyzed urea hydrolysis. Proteus mirabilis, a Gram-negative rod-shaped bacterium most noted for its swarming motility and urease activity, frequently causes catheter-associated urinary tract infections (CAUTI) that are often polymicrobial.
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