Emerging Diseases Related To Food

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Powdered Infant Formula
milk based

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Enterobacter sakazakii infection

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Infection of blood and central nerve in neonates and infants

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Enterobacter sakazakii infection

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sepsis, meningities, necrotizing enterocolitis

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Enterobacter sakazakii infection

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Infants <28 days

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Enterobacter sakazakii infection

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ubiquitous

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Enterobacter sakazakii infection

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bacterium found in milk, herbs/spices, meat sausages, baby foods, vegetables

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Enterobacter sakazakii infection

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Symptoms : seizures, brain abscess, hydrocephalus, developmental delay and death

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Enterobacter sakazakii infection

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33- 80 % infant infected die

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Enterobacter sakazakii infection

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Treatment: combination of ampicillin with gentamicin or chloraamphenical
Developed resistance to ampicillin

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Enterobacter sakazakii infection

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Gram -ve rod,
Enterobacteriaceae family

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Enterobacter sakazakii infection

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Bacterium thermotolerant

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Enterobacter sakazakii infection

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minimum growth 6
optimal 37- 43

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Enterobacter sakazakii infection

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exact virulence unknown

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Enterobacter sakazakii infection

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bacterium could attached host cells and survive inside macrophage

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Enterobacter sakazakii infection

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Produce capsule materials
help survive environment

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Enterobacter sakazakii infection

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Attached to silicon and plastic surface

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Enterobacter sakazakii infection

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Form biofilm which is difficult to remoce

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Enterobacter sakazakii infection

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Lethal dose 10^5 to 10 ^ 8 cells

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Enterobacter sakazakii infection

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contaminated during manufacturing

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Enterobacter sakazakii infection

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contaminated during infant formula preparation , eg utensil , spoon

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Enterobacter sakazakii infection

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Powdered milk is not sterilized
found in PIF 0.36- 66 CFU per 100g

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Enterobacter sakazakii infection

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suitable breast milk substitue

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accordance with the codex alimentarius commission standard
Enterobacter sakazakii infection

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abdominal and bowel symptoms that occur with sufficient frequency in affected patients.

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Irritable Bowel Syndrome

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symptoms : abdominal pain, bloating and bowel disturbance ( constipation or diarrhea)

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Irritable Bowel Syndrome

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etiology: multifactor
hypersensitivity
stress
gut microflora alteration

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Irritable Bowel Syndrome

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small intestine bacterial overgrowth

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Irritable Bowel Syndrome

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increasing numbers
populations changes

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Irritable Bowel Syndrome

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More Gram +ve bacteria
Bacteroides, Streptococcus, Lactobavillus

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Irritable Bowel Syndrome

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Gram - ve Escherichia

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Irritable Bowel Syndrome

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Stay ill for 5 years

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Irritable Bowel Syndrome

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Treatment: Broad Spectrum antibiotics - temporary effect

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Irritable Bowel Syndrome

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Probiotic treatment:
Bifdobacterium reduced abnormal inflammation

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Irritable Bowel Syndrome

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developed due to previous infectious gastroenteritis

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Post Infection IBS

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possible organisms: Camplylobacter, Salmonella, Shigella

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Post Infection IBS

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Campylobacter jejuni -stimulate infiltration of enterochromaffin (EC) and lymphocyte cells

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Post Infection IBS

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more frequent in young female

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Post Infection IBS

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Campylobacter jejun

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stimulate infiltration of enterochromaffin (EC) and lymphocyte cells
Post Infections IBS

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increased gut permeability and inflammation

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Post Infection IBS

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increased EC cells, CD3 lymphocytes and macrophage IL1

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Post Infection IBS

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abnormal seretonin metabolism, increased 5- HT ( 5 hydroxytryptamine)

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Post Infection IBS

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bacterial gastroenteritis

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Post Infection IBS

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Occurs after a gastrointestinal infection with enterohemarrhagic Escherichia coli

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Hemolytic Uremic Syndrome (HUS)

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Most common in children under 5 years old

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Hemolytic Uremic Syndrome (HUS)

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Leading cause of acute renal failure in children

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Hemolytic Uremic Syndrome (HUS)

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Monitored by Foodnet

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Hemolytic Uremic Syndrome (HUS)

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Symptoms : early - vomiting, bloody diarrhea, weakness, irritability

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Hemolytic Uremic Syndrome (HUS)

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Symptoms: later- low or no urine output, Blood in urine, anemia, loss of consciousness, high blood pressure

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Hemolytic Uremic Syndrome (HUS)

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Mortality rate 5 - 15%

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Hemolytic Uremic Syndrome (HUS)

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Treatment: Dialysis
Medications such as corticosteroids

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Hemolytic Uremic Syndrome (HUS)

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Transfusions of red blood cells and platelets

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Hemolytic Uremic Syndrome (HUS)

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Primary EHEC serotype is O157: H7

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Hemolytic Uremic Syndrome (HUS)

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other bacteria : salmonella shigella
other than O157

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Hemolytic Uremic Syndrome (HUS)

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Primary virulence factor is shiga toxin

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Hemolytic Uremic Syndrome (HUS)

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Shiga toxin ( stx) -ve bacteria

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Hemolytic Uremic Syndrome (HUS)

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Intimin positive ( eae+)

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Stx negative bacteria
Hemolytic Uremic Syndrome (HUS)

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Stx gene may have been lost during infection mediated by bacteriophage

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Hemolytic Uremic Syndrome (HUS)

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Shiga toxin ( Stx) inhibits protein synthesis within target cells

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Hemolytic Uremic Syndrome (HUS)

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Stx could lyse blood cells - hemolytic anemia

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Hemolytic Uremic Syndrome (HUS)

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Cellular debris accumulates within the boly's tiny blood vessels

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Hemolytic Uremic Syndrome (HUS)

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Formation of micro clot in the blood vessel rich kidneys leads to impaired kidney function

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Hemolytic Uremic Syndrome (HUS)

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can cause damage to other major organs

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Hemolytic Uremic Syndrome (HUS)

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AKA reither's syndrome , post infectious arthritis

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Reactive Arthritis ( ReA)

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autoimmune disease developed after gastrointestinal and genitourinary infection

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Reactive Arthritis ( ReA)

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Symptoms: inflammation of joints ( arthritis), conjunctivitis ( eyes), skin, urinary tract ( urethritis)

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Reactive Arthritis ( ReA)

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symptoms reoccur in 50% of cases

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Reactive Arthritis ( ReA)

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Treatment: anti inflammatory and pain relieving drugs

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Reactive Arthritis ( ReA)

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Genetic factor : 60 - 85% patients are HLA B27 positive

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Reactive Arthritis ( ReA)

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What is HLA

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Human Leukocyte antigen
Reactive Arthritis ( ReA)

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HLA =?

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Human major histocompatibility complex ( MHC)
Reactive Arthritis ( ReA)

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cell surface molecules --> tissue typing

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Human Leukocyte antigen
Reactive Arthritis ( ReA)

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help present antigen at the surface of antigen presenting cell (APC) to T cells

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Human Leukocyte antigen
Reactive Arthritis ( ReA)

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B27 is?

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Subtype of class 1 MHC , B gene
Human Leukocyte antigen
Reactive Arthritis ( ReA)

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B27 is strongly associated with?

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Spondyloarthritis ( including ReA)
Human Leukocyte antigen
Reactive Arthritis ( ReA)

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which 2 factors are required to trigger ReA?

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B27 and previous infection
Human Leukocyte antigen
Reactive Arthritis ( ReA)

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Which previous infections are they?

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Gastrointestinal bacteria
and genitourinary infection
Human Leukocyte antigen
Reactive Arthritis ( ReA)

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Gastrointesinal Bacteria

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Yersinia, Camplylobacter , Salmonella, Shigella
Human Leukocyte antigen
Reactive Arthritis ( ReA)

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Genitourinary Infection (STD)

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chlamydia and gonorrhea
Human Leukocyte antigen
Reactive Arthritis ( ReA)

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How a distal(2 or more) infection causes ReA?

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Hypo 1: presence and persistence of bacterial antigens in the synovial fluid.
Human Leukocyte antigen
Reactive Arthritis ( ReA)

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Presence of Viable but non culturable bacteria

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Hypo 1
Human Leukocyte antigen
Reactive Arthritis ( ReA)

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Presence of immunogenic bacterial antigens

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such as Yersinia adhisin YadS, bind specifically to joint collagens
Human Leukocyte antigen
Reactive Arthritis ( ReA)

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Bacterial DNA contains un-methylated CpGF motifs, stimulates monocytes

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presence of immunogenic bacterial antigens
Human Leukocyte antigen
Reactive Arthritis ( ReA)

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Bacterial LPS could stimulate macrophage and cytokineses

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presence of immunogenic bacterial antigens
Human Leukocyte antigen
Reactive Arthritis ( ReA)

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antigen mimicry leads to autoimmunity

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Hypo 2
ReA

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What is best studied in Yersinia enterocolitica
T cells, stimulated by pathogen, cross react to self antigen in the joint
Yersinia YopH mimics CD45
mimicry among evolutionarily conserved epitopes, hsp60

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Hypo2
ReA

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autoimmune disorder affecting peripheral nerve system after gastrointestinal or respiratory infection

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Guillain - Barre Syndrome (GBS)

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One of the leading cause of acute non trauma induced paralysis in the world

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Guillain - Barre Syndrome (GBS)

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Symptoms: symmetrical weakness from the lower limbs and rapidly progresses in an ascending fashion.

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Guillain - Barre Syndrome (GBS)

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rubbery legs, drooling, difficulty swallowing, respiratory difficulty

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Guillain - Barre Syndrome (GBS)

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Treatment: Supportive care
Intravenous Immunoglobulins

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Guillain - Barre Syndrome (GBS)

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What is the organisms involved in GBS

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campylobacter jejuni

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Mechanisms of GBS

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T cells stimulate by infection --> attack ganliosides on neuron ..> loss if myelin -- > muscle paralysis

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Can myelin regrow

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Yes and patient will recover
GBS