Bacterial Gi Diseases - Micro Ch 27

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Most microbes are killed by

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stomach acid

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when you eat a bolus (lg meal) parts of the material can

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pass on into the intestinal tract before they are completely mixed and well digested. the bacteria survive and colonize in intestines

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other microbes produce

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toxins that are stable to stomach acid. they pass thru the GI tract and cause diseases, d/v/dehydration/w or w/o fever

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disease produced by a toxin is called ________

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intoxication

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disease continues until

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the microbes/toxins are passed out of the system or neutralizede by some host defense mechanism such as an antibody

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many toxins cause

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fluids to rush out of intestinal endothelial cells to produce a watery diarrhea

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some microbes

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damage intestinal lining sufficiently to produce ulcerations with a resulting bloody diarrhea, which is called dysentery

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the most common mode of transmission of a GI bact. disease is

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fecal oral. when someone has diarrhea and doesn't wash hands properly

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trasmission of bacteria from

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animal slaughter houses has also been a problem. esp ground A cut meats such as hamburger and chicken

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during handling of raw meat

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bacteria can be spread into the center of the meat. and bacterial killing is incomplete unless the meat is well done throughout. avoid pink burgers/chx highly recommended

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bacteria share

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DNA among themselves frequently, most commonly thru conjunction in which small plasmids, such as R-factors, can transfer multidrug resistance ina single mating. thus antibiotic resistance is a factor that needs to be considered when tx these infxns

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2 of the most common GI bacterial diseases are

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gastroenteritis (inflammation of the stomach and intestinal lining) and dysentery (watery diarrhea with b lood and mucus, pain, fever)

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Typhoid Fever characteristics:

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bact. GI disease; gram- rods, human to human spread, often via food

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organisms causes typhoid fever:

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salmonella typhi

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typhoid fever presents with

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intestinal ulcerations with bloody stools; bacteriemia develops with resultant skin hemorrhages called rose spots and a steplattder fever that goes up and down each day

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typhoid fever spreads from

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symptomatic and asymptomatic chronic carriers who fail to wash adequately and/or cont to work.

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chronic carriage of typhoid can last

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thru entire life

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Mary Mallon

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typhoid mary- cooked for wealthy NY in 1800s, chronic carrier with asymptomatic S. typhi in her gall bladder. when she used the BR she failed to wash adequately, spread S. typhi to the food, and killed er hosts-then moved on. caught - house arrest 2x

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Chlorea ________disease of _______

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bact disease of GI tract

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Characteristics of Cholera:

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curved (comma shaped) gram- rods; choleragen; rice-water stool; human and fresh water transmission

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organism of Cholera

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vibrio cholerae

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vibrio cholerae is a

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comma shaped organism that produces the choleragen exotoxin and causes the disease cholera

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choleragen causes

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massive losses of electrolytes- 20Liters/d- called rice water stool because of its watery appearance and small granules that look like rice grains.

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most effective tx of cholera

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is to measure the fluid lost and replace that much volukme with an appropriate eletrolyte solution

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V. cholerae can grow

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freely in water as well as in humans

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major outbreaks of cholera have occured in

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central america (almost to the texas border), south america, and africa where waters are contaminated.

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cholera has caused

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seven pandemics since 1800. In pandemics from 1832-36, 200,000 people in north america died

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salmonellosis is a ____ disease of ___

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bacterial disease of GI tract

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salmonellosis characteristics:

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gram- rod; reptile,livestock (zoonosis) and human transmisssion

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there are ____________known serotypes of salmonella

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2400. but do cause salmonellosis, a less severe form of diarrhea

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the different serotypes of salmonellosis produce

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different surface antigens, and each antigenic type induces a different immune response.

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salmonellosis is

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grastroenteritis, when caused by salmonella

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salmonellosis is often transmitted from

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reptiles (turtles) which is why we have laws against interstate transport of turtles to reduce the spread of salmonellosis

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disease transmission of salmonellosis from an animal to human is called

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zoonosis

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the mechanism of zoonic transmission of salmonellosis

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hold the animal; put fingers in mouth

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salmonellosis is also assoc with

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raw eggs (in any dish), poultry, raw milk, and mayonnaise

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because salmonellosis grows in

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chickens and other livestock, contamination is frequent

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salmonella are ____________ meaning

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lactose negative, meaning they can't grow on lactose

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Traveler's Diarrhea is a _____ disease of the ______________

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bacterial disease of the GI tract

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Characteristics of Traveler's Diarrhea:

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bact. GI tract; gram- rod; carried by all mammals; traveler's diarrhea, enterotoxin, cystitis

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The coliform______________ is a natural inhabitant of the __________

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E. coli
colon

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E. Coli is a

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gram- bacteria that contains endotoxin, the lipid A of lipopolysaccharide (LPS) that induces fever when the bacteria invade

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E. coli i identified by

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its ability to ferment lactose on an EMB (eosin methylene blue) agar plate to produce dark colonies that result when lactose is digested by the bacteria

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coloform presence is commonly used to

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trace the occurrence of fecal contamination, such as in well water

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Because lactose' E. coli are

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present in high numbers in feces (one hundred billion/gram) the outgrowth of E. coli on EMB agar is extremely sensitive for the detection of fecal contaminants

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most E. coli are

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harmless; some strains are not and frequently cause UTI (esp in female d/t close proximity of urethral opening and shortness of urethra)

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transmission of E. coli are by

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the five Fs: feces, flies, fingers, food, fomites

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____________is the key to reduction of diseases caused by coliforms

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sanitation: sanitary sewer systems, flush toilet, sewage tx, chlorination of water essential to prevent mass outbreaks of enteric diseases. flush toilets have reduced incidence dramatically.

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some strains of E. coli secrete

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enterotoxins that cause Traveler's Diarrhea, seen in people who travel to foreign coutries where they contact E. coli with a different enterotoxin.

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infantile diarrhea

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is often caused by the local strain of E. coli when a baby first encounters it

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new strain 0157:H7

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strain of E coli has killed a nhumber of kids <10yo in US d/t potent enterotoxin. the acid-stable toxin is preformed in food while bacterial are normally killed by stomach acid. ABT tx not useful.

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the enterotoxin of 0157:H7, causes

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bloody diarrhea, kidney failure, coma, and death

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transmission of 0157:H7 is via

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fecal-oral route or food/water-incompletely cooked hamburger, vegetables, and even fruit.

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e. coli is the cause of

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most common cause of cystitis (inflammation of bladder) or bacteriuria (bacteria in urine-the > reason a pt visits MD/y in US) tx is difficult d/t ABT resistance. susceptibility testing is essential to tx. usually febrile-bacteria invade the tissue

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UTI rate increases with

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frequency of sex / spermicide use

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nearly all UTI infections occur

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in the female from her own resident E. coli

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camplyobacteriosis characteristics:

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bact GI; short, helical rods- comma shaped, microaerophilic

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organism of camplyobacteriosis

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camplyobacter jejuni

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camplyobacteriosis causes:

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campylobacteriosis (d/n) and frequently dysentery. 2 mill cases/y in US- 1/2 lead to bloody diarrhea (dysentery) and fever

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mild campylobacteriosis is normally

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untx with recovery in a week

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dysentery is tx with

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erythromycin

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a rather unusual growth property of campylobacter is

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its need for reduced amt of O2 (microaerophilic)

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campylobacter shape

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helical but short- comma shaped, only part of a helical turn

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campylobacter motility is

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d/t a polar single flagellum at one end

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many domestic animals carry campylobacter but it is most common in

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poultry. contaminated milk and water have also been assoc with some outbreaks.

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prevention of campylobacter includes

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pasteurization of milk, chlorination of water, and care in handling/cooking poultry

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gastritis characterisitcs

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bact GI; short, helical rods-comma shaped, microaerophilic, gastric ulcer and gastric ca

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organism responsible for gastritis

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heloicobacter pylori. discovered 1980

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gastritis is

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inflammation of the stomach. and is strongly assoc with gastric ulcers and gastric ca.

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H. pylori uses

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its flagella to cork screw thru the gastric mucous coating and attach to epithelial cells near neutral environment d/t the mucous layer. once there they multiply = more damage that can lead to ulcers/ca

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H. pylori shape

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helical or comma shaped, short rod that is also a microaerophile, gram- rod similar to C. jejuni

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H. pylori makes

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urease, an enzyme that breaks down urea to release ammonia

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urea is a

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breakdown product of protein/amino acid digestion in the stomach

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the ammonia produced by H.pylori leads to

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the loss of the protective mucous layer that covers the stomach's lining of epithelial cells, so stomach acid damages the cells and the bacteria colonize the stomach more readily.= gastric ulcer/ca

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bacillary dysentery characterisitcs

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bact GI; gram- rod; bacillary dysentery

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diarrhea indicates

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frequent watery stools

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dysentery from Shigella dysenteriae are

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watery stools that ontain mucus and blood

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the bloody diarrhea caused by Shigella is called a

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raspberry jam stool and ontains blood and sheets of pus

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the disease is called basillary dystery because of the

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great numbers of bacilli in the stool

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the frequency of Shigella infections in day care centers has

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increased from 3.5 to 22% in the past 25y. infected kids go home and spread infexn to 53% of family. of these cases 40% present with bloody diarrhea

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Shigella is lactose ____

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negative, hence not a coliform.

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Shigella varies from other gram negatives in that it is

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nonmotile

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characteristics of Botulism:

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bact GI; gram + rod, spore former, anaerobe, botulinum toxin

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Botulism occurs when

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canned foods are ingested that were not adequately heated to kill all the Clostridium botulinum spores.

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the botulinum toxin is

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so potent that detectable growth (by odor/bulging of can) need not be present for intoxication to result

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one ounce of botulinum toxin is

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enough to kill the population of the US.- considered a potential bioterrorism agent

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botulinum toxin is

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absorbed into bloodstream and acts on the nerves

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first s/s of botulism

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dizziness, blurred vision, and often nausea and ABD pain. paralysis follows with resp paralysis the most common cause of death

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occassionaly in botulism the bacteria

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infect and grow in a wound and spread toxin from there intot the bloodstream

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infant botulism has been linked to

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SIDS

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the botulinum toxin has been used

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in minute quantities to relax muscles in some disease states including strabismus (crossed eyes)

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pressure cookers eliminate the spores well but also remove O2 so

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if tx fails to provide adequate pressure, temp, or time to eliminate all spores, the cells can germinate to grow anaerobically and produce toxin

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proper sterilization requires

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fifteen pounds of pressure, 15 min, 121C

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for home canned green beans and corn

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boil 10 min to destory toxin, green beans and corn have been major sources of botulism. acid fruits /veg don't allow for microbial growth and toxin production.

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bacillus cereus

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a closely related organism to botulinum also cause food poisoning esp assoc with rice and has been a problem when the organism survives cooking.process.

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Food poisoning characteristics

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bact GI; gram+ staphylococcus; short incubation time about 4h

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many strains of staph secrete

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an enterotoxin, which is the most common cause of food poisoning

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____% of pts require ______________

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5% fluid replacement and the rest recover spontaneously

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incubation time for food poisoning is

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1-6h

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food poisoning is a

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pure toxemia because the stomach acid kills the organisms. No ABT. toxin passes thru stomach unharmed- resistant to boiling/freezing.

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food containing food poisoning enterotoxin must be

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disposed of

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projectile vomiting

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can reach up to 20 ft

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clostridium perfringens characteristics

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bact GI; gram+ rod; spore former; anaerobe; enterotoxin

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c. perfringens causes

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which causes gas gangrene also causes food poisoning

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incubation time for c. perfringens is

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7-15h. it is longer than staph because the bacteria infect, grow in the GI tract, and make the enterotoxin in situ

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c. perfringens s/s

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diarrhea and abd cramps are primary s/s symptoms end spontaneously w/i 24h as a rule

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transmissio of c. perfringens:

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normally via protein rich foods of animal origin that have been allowed to remain warm for long periods

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destruction of c. perfringens

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heating food to near boiling temp destroys the toxin but not the spores

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brucellosis characteristics:

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bact GI; small, gram- coccobacillus (some of the rods are short so they appear to be spherical); fastidious (blood is typically added to growth media); slow growing (may take 30d to form colonies)

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brucella species primarily cause

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disease (brucellosis) in animals and are a common cause of abotion in cattle, swine, sheep and goats.

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human acquire brucella

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from handling such animals, their meat, or dairy products

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brucella incubation time

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2-4weeks

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most human outbreaks of brucella

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occur when drink raw milk

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s/s of brucellosis

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fever, anorexia, abd pain, d/n. if untx fever cycles up and down which gives rise to its common name of undulant fever.

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brucella may grow in

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tissues to cause a wide variety of s/s including depression which complicates dx

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brucella species survive and grow well in

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macrophages. macrophages only kill the bacteria upon activation. these bacteria are primarily intracellular pathogens

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brucellosis tx

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ABT imp, however even prolonged tx not always effective because the bacteria are more resistnat to antibiotics when inside human scells, relapse is common.

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prevention of brucellosis

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eliminating infected animals