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GASTROENTERITIS
Gastroenteritis
• Inflammation of stomach or intestines
– Inhibits nutrient absorption and excessive H2O and
electrolyte loss
• Bacterial
• Viral
• Parasites
• Poisoning by microbial toxins
– food borne intoxication
• Signs and Symptoms:
– General features: diarrhea, loss of appetite, abdominal
cramps, nausea, vomiting and possibly fever
– Dysentery
– Typically self Limiting
• Enteric fevers
– Systemic with severe headache, high fever, abscesses,
intestinal rupture, shock and death
• Epidemiology
– Occurs worldwide
– Oral to fecal route of transmission
• Water common reservoir
• Overcrowding & poor sanitation are risk factors
• Animals may be source of infection
• Prevention
– Hand washing
– Proper food handling and complete cooking
– Pasteurization of milk and juices
– Adequate sanitation
– Safe water supplies
• Treatment
– Rapid replacement of fluids and electrolytes
– Anti-nausea medication
– Antimicrobials may be used in severe cases
Bacterial Gastroenteritis
• 3 groups of gram negative bacteria account for
most bacterial intestinal infections:
– Vibrio cholerae (Cholera)
– Enterics (Salmonella, Shigella, E. coli)
– Campylobacter jejuni
Cholera
• Causative agent: Vibrio cholerae
• High infectious dose
– Bacteria sensitive to stomach acid
– Adheres to small intestine and multiply
– Bacteria don’t enter cells
• Cholera toxin
– Potent exotoxin
– Causes intestinal cells
to rapidly pump out
electrolytes
– Passive osmotic H2O
loss follows
– Metabolic acidosis
– Shock
• Heavy loss of fluid
– “rice-water stool”
• Up to 20L of fluids lost per day
• May discharge 1 million bacteria per ml of feces
• Untreated cases potentially fatal
– Fluid/electrolyte replacement
– Tetracycline reduces toxin production
Shigellosis
• Causative Agent: Shigella sp.
– S. dysenteriae, S. flexneri, S. boydii, S. sonnei
• Low infecting dose
– Bacteria not sensitive to stomach acid
– Characterized by fever and dysentery
•Infects cells of large intestine and
initiates intense inflammatory
response
•Dead cells slough off
•Produces areas covered with
pus and blood
• All species produce enterotoxin and type III
secretion systems
• S. dysenteriae produces powerful endotoxin
– shiga-toxin
• Ciprofloxacin, rifampin or azithromycin may reduce
duration and infectivity
Traveler’s Diarrhea
• Causative Agent: Escherichia coli
– Multiple antigenic strains (O, H, K)
– Virulent strains have fimbriae, adhesions and
multiple toxins
• Enterotoxigenic E. coli
– Enterotoxins
– Type III secretion system
– Typically self limiting
• Enterohemorrhagic E. coli
– O157:H7
– Produce potent Shiga-like toxins and type III secretion
systems
• Antimicrobials cause increase in toxin production
Salmonellosis and Typhoid Fever
• Causative agent: Salmonella enterica
– 2000 strains (serotypes)
– Typhimurium and Enteritidis commonly cause
Salmonellosis
– Typhi and Paratyphi cause Typhoid Fever
• Common intestinal
flora of many animals
• Contaminated animal
products are reservoir
• Reptiles, eggs and
undercooked
poultry
•Virulent strains tolerate stomach
acid and pass to intestines
•Toxin induces phagocytosis in
intestinal cells
•Pathogen reproduces inside
phagosome killing host cell
•Bacteria (Typhi) may pass倠䁝
through intestinal cells into
bloodstream
Campylobacteriosis
• Causative agent: Campylobacter jejuni
– Leading cause of bacterial diarrhea in United States
– Estimated 1million cases annually with ~100 deaths
• Associated with poultry
– Low infecting dose
• Virulent strains possess adhesions, cytotoxins
and endotoxin
– Induce endocytosis in cells of intestine and initiate
inflammation and bleeding lesions
• Non-motile mutants are avirulent
• Severe cases treated with ciprofloxacin or
azithromycin
Bacterial Food Intoxication
• Staphylococcus aureus
– Halotolerent; grows well in foods at room temp
– Associated with cafeterias and social functions
• 5 heat stable enterotoxins:
– 1000 for up to 30 min
– Stimulate muscle contractions, nausea and intense
vomiting, diarrhea and cramping
– Acute and self limiting
• symptoms begin 4-6 hrs after consumption and
end within 24 hrs
Botulism
• Causative agent:
– Clostridium botulinum
• Obligate anaerobic, Gram +, spore forming bacillus
– Produce 7 different neurotoxins
• One of most deadly toxins known
• Signs & Symptoms
– Dizziness, dry mouth, blurred vision
– Abdominal symptoms include pain, nausea,
vomiting and diarrhea or constipation
– Progressive paralysis
• Paralysis of respiratory muscles most common
cause of death
• 3 forms of botulism:
– Food-borne botulism – progressive paralysis of
all voluntary muscles due to toxin production
– Wound botulism – similar symptoms
– Infant botulism – bacteria grow in the intestines,
producing non-specific symptoms
• “floppy baby syndrome”
Gastroenteritis
Gastroenteritis
Gastroenteritis
Gastroenteritis

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Gastroenteritis

  • 2. Gastroenteritis • Inflammation of stomach or intestines – Inhibits nutrient absorption and excessive H2O and electrolyte loss • Bacterial • Viral • Parasites • Poisoning by microbial toxins – food borne intoxication
  • 3. • Signs and Symptoms: – General features: diarrhea, loss of appetite, abdominal cramps, nausea, vomiting and possibly fever – Dysentery – Typically self Limiting • Enteric fevers – Systemic with severe headache, high fever, abscesses, intestinal rupture, shock and death
  • 4. • Epidemiology – Occurs worldwide – Oral to fecal route of transmission • Water common reservoir • Overcrowding & poor sanitation are risk factors • Animals may be source of infection
  • 5. • Prevention – Hand washing – Proper food handling and complete cooking – Pasteurization of milk and juices – Adequate sanitation – Safe water supplies • Treatment – Rapid replacement of fluids and electrolytes – Anti-nausea medication – Antimicrobials may be used in severe cases
  • 6. Bacterial Gastroenteritis • 3 groups of gram negative bacteria account for most bacterial intestinal infections: – Vibrio cholerae (Cholera) – Enterics (Salmonella, Shigella, E. coli) – Campylobacter jejuni
  • 7. Cholera • Causative agent: Vibrio cholerae • High infectious dose – Bacteria sensitive to stomach acid – Adheres to small intestine and multiply – Bacteria don’t enter cells
  • 8. • Cholera toxin – Potent exotoxin – Causes intestinal cells to rapidly pump out electrolytes – Passive osmotic H2O loss follows – Metabolic acidosis – Shock
  • 9. • Heavy loss of fluid – “rice-water stool” • Up to 20L of fluids lost per day • May discharge 1 million bacteria per ml of feces • Untreated cases potentially fatal – Fluid/electrolyte replacement – Tetracycline reduces toxin production
  • 10. Shigellosis • Causative Agent: Shigella sp. – S. dysenteriae, S. flexneri, S. boydii, S. sonnei • Low infecting dose – Bacteria not sensitive to stomach acid – Characterized by fever and dysentery
  • 11. •Infects cells of large intestine and initiates intense inflammatory response •Dead cells slough off •Produces areas covered with pus and blood
  • 12. • All species produce enterotoxin and type III secretion systems • S. dysenteriae produces powerful endotoxin – shiga-toxin • Ciprofloxacin, rifampin or azithromycin may reduce duration and infectivity
  • 13. Traveler’s Diarrhea • Causative Agent: Escherichia coli – Multiple antigenic strains (O, H, K) – Virulent strains have fimbriae, adhesions and multiple toxins • Enterotoxigenic E. coli – Enterotoxins – Type III secretion system – Typically self limiting
  • 14. • Enterohemorrhagic E. coli – O157:H7 – Produce potent Shiga-like toxins and type III secretion systems • Antimicrobials cause increase in toxin production
  • 15. Salmonellosis and Typhoid Fever • Causative agent: Salmonella enterica – 2000 strains (serotypes) – Typhimurium and Enteritidis commonly cause Salmonellosis – Typhi and Paratyphi cause Typhoid Fever
  • 16. • Common intestinal flora of many animals • Contaminated animal products are reservoir • Reptiles, eggs and undercooked poultry
  • 17. •Virulent strains tolerate stomach acid and pass to intestines •Toxin induces phagocytosis in intestinal cells •Pathogen reproduces inside phagosome killing host cell •Bacteria (Typhi) may pass倠䁝 through intestinal cells into bloodstream
  • 18.
  • 19. Campylobacteriosis • Causative agent: Campylobacter jejuni – Leading cause of bacterial diarrhea in United States – Estimated 1million cases annually with ~100 deaths • Associated with poultry – Low infecting dose
  • 20. • Virulent strains possess adhesions, cytotoxins and endotoxin – Induce endocytosis in cells of intestine and initiate inflammation and bleeding lesions • Non-motile mutants are avirulent • Severe cases treated with ciprofloxacin or azithromycin
  • 21. Bacterial Food Intoxication • Staphylococcus aureus – Halotolerent; grows well in foods at room temp – Associated with cafeterias and social functions
  • 22. • 5 heat stable enterotoxins: – 1000 for up to 30 min – Stimulate muscle contractions, nausea and intense vomiting, diarrhea and cramping – Acute and self limiting • symptoms begin 4-6 hrs after consumption and end within 24 hrs
  • 23. Botulism • Causative agent: – Clostridium botulinum • Obligate anaerobic, Gram +, spore forming bacillus – Produce 7 different neurotoxins • One of most deadly toxins known
  • 24. • Signs & Symptoms – Dizziness, dry mouth, blurred vision – Abdominal symptoms include pain, nausea, vomiting and diarrhea or constipation – Progressive paralysis • Paralysis of respiratory muscles most common cause of death
  • 25. • 3 forms of botulism: – Food-borne botulism – progressive paralysis of all voluntary muscles due to toxin production – Wound botulism – similar symptoms – Infant botulism – bacteria grow in the intestines, producing non-specific symptoms • “floppy baby syndrome”