A 24-year-old woman develops acute pyelonephritis with flank pain and fever. Urine culture grows Escherichia coli. The bacterial adhesin most important for enabling ascent of this organism from the bladder to the renal pelvis binds to:

• A CEACAM receptors on respiratory epithelium
• B GM1 ganglioside on intestinal epithelium
• C Gb3 glycosphingolipid on glomerular endothelium
• D Gal alpha 1-4 Gal receptors (globoside) on uroepithelial cells ✓

Explanation

P fimbriae (pyelonephritis-associated pili) of uropathogenic E. coli recognize the Gal alpha 1-4 Gal beta disaccharide of the globoside series of glycolipids present on uroepithelial cells. Individuals expressing the P blood group antigen have more receptors and are at higher risk of pyelonephritis. GM1 ganglioside is the receptor for cholera and LT toxins, Gb3 is the Shiga toxin receptor, and CEACAM binding is typical of Neisseria.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.