What causes Diarrhea IEHA 2008

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August 28,2008 presentation to the Illinois Environmental Health Association Food Safety Conference on the causes of Diarrhea on the cellular level.

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What causes Diarrhea IEHA 2008

  1. 1. Steven Lipton M.Ed. LEHP President Biotest Services Inc.
  2. 2. Foodborne Infection <ul><li>A foodborne Infection is caused by bacteria directly causing damage to the human body They must be alive and will require longer periods of time to grow to sufficient numbers to cause illness. The body will require more time to fight this type of illness </li></ul>
  3. 3. Foodborne Intoxication <ul><li>A foodborne intoxication is caused by wastes (toxins) produced by the bacteria. The bacteria does not have to be alive to cause illness. Some toxins are extremely heat stable and can not be destroyed by cooking. Toxins tend to cause illness rapidly. With a few exceptions, these will be relatively quick illnesses. </li></ul>
  4. 4. Vomiting: Biting off…
  5. 5. Where the Monsters Are
  6. 6. Digestive System Small intestine Mouth Esophagus Rectum Large Intestine Liver Stomach
  7. 7. Small Intestine Large Intestine Stomach Liver
  8. 8. <ul><li>An Excess of water and loose stools in the Lower GI which is released through the rectum </li></ul>
  9. 9. <ul><li>Water and semi-digested material in the upper GI which is relieved through the mouth by abdominal contractions. </li></ul>Emesis
  10. 10. Basic Microbiology
  11. 11. <ul><li>Bacilli </li></ul><ul><li>Cocci </li></ul><ul><li>Spirilli </li></ul>MRSA E. Coli O157:H7 Campylobacter
  12. 12. <ul><li>GRAM NEGATIVE </li></ul><ul><li>GRAM POSITIVE </li></ul>Peptidoglycan Lipid Layer
  13. 13. <ul><li>Enterotoxins – toxins that attack the Digestive system </li></ul><ul><li>May be either an Exotoxin or Endotoxin </li></ul>
  14. 14. <ul><li>Endotoxins – gram negative </li></ul><ul><li>Lipopolysacchride (heat stable) </li></ul>
  15. 15. <ul><li>Salmonella -- Lysis of cell </li></ul><ul><li>Starts an abnormal immune response </li></ul>
  16. 16. <ul><li>Exotoxins –gram positive, gram negative </li></ul><ul><ul><li>Protein (Heat Stable or Heat liable) </li></ul></ul>
  17. 17. Exotoxin Types: <ul><li>Type I – acts on the cell surface </li></ul><ul><li>Type II – membrane damaging </li></ul><ul><li>Type III - intracellular </li></ul>
  18. 18. Pore forming or AB5 toxins A B B <ul><li>Creates unregulated pore in cell </li></ul><ul><li>Delivers the toxin payload(A) </li></ul>
  19. 19. <ul><li>Type III Injectors </li></ul>Cell
  20. 20. <ul><li>Secretory </li></ul><ul><li>Osmotic </li></ul><ul><li>Inflammatory </li></ul>
  21. 21. <ul><li>Cells secrete </li></ul><ul><ul><li>water </li></ul></ul><ul><ul><li>sugar </li></ul></ul><ul><ul><li>Electrolytes (NaCl, KCl) </li></ul></ul><ul><li>cAMP or gAMP over activated </li></ul>
  22. 22. <ul><li>Secretory </li></ul>NaCl Cl- NaCl NaCl NaCl Na Cl- Cl- Cl- cAMP H-O-H H-O-H H-O-H H-O-H
  23. 23. <ul><li>Substances not absorbed by the body attract water in the system </li></ul>
  24. 24. Lactose Intolerance Lactose Galactose Liver Glucose Lactase
  25. 25. H-O-H H-O-H H-O-H H-O-H H-O-H H-O-H H-O-H H-O-H H-O-H Lactase Present
  26. 26. H-O-H H-O-H H-O-H H-O-H H-O-H H-O-H H-O-H H-O-H H-O-H
  27. 27. <ul><li>Damage to cells, or response to cell damage </li></ul><ul><li>Combination of types above </li></ul>
  28. 28. Inflammatory H-O-H H-O-H H-O-H H-O-H H-O-H H-O-H H-O-H H-O-H H-O-H
  29. 29. <ul><li>Superantigen </li></ul><ul><li>Pore forming (MRSA) </li></ul>
  30. 30. Immune response 0.001-0.0001%
  31. 31. Immune response Up to 20%
  32. 32. <ul><li>Not Classified as Diarrhea </li></ul><ul><li>Blood and Mucus emitted in feces </li></ul><ul><li>Damage to cells and mucosal linings </li></ul>
  33. 33. <ul><li>Shiga Toxin (verotoxin) </li></ul><ul><li>AB 5 toxin </li></ul><ul><li>‘ A’ enzyme stops protein synthesis </li></ul>
  34. 34. <ul><li>ETEC (Enterotoxin) </li></ul><ul><ul><li>LT & ST </li></ul></ul><ul><ul><li>Infective @(10 8 ) </li></ul></ul><ul><ul><li>Diarrhea w/o fever </li></ul></ul><ul><li>EIEC (enteroinvasive) </li></ul><ul><ul><li>Invasive </li></ul></ul><ul><ul><li>Infective @(10 6 ) </li></ul></ul><ul><li>EHEC (enterohemmoragic) </li></ul><ul><ul><li>O157:H7 </li></ul></ul><ul><ul><li>Moderately invasive (Type III injector/pedestal) </li></ul></ul><ul><ul><li>Shiga toxin producing </li></ul></ul><ul><li>EPEC (enteropathogenic) </li></ul><ul><ul><li>Moderately invasive, some report of shiga toxin </li></ul></ul><ul><ul><li>Infective @(10 6 ) </li></ul></ul><ul><li>EAEC (enteroaggregative) </li></ul><ul><ul><li>Watery diarrhea </li></ul></ul>
  35. 35. Questions? <ul><li>[email_address] </li></ul><ul><li>http://Biotestservices.com </li></ul><ul><li>PowerPoint presentation available at </li></ul><ul><li>http://EHblogger.blogspot.com </li></ul><ul><li>http://shoestringsanitarian.blogspot.com </li></ul>

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