Gastroenteritis

Enny Suswati

2/3/2014

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

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Gastroenteritis

 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

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Gastroenteritis

 Epidemiology Occurs worldwide Oral to fecal route of transmission

Water common reservoir Overcrowding & poor sanitation are risk factors Animals may be source of infection

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Gastroenteritis

 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
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Bacterial Gastroenteritis
3 groups of gram negative bacteria account for most bacterial intestinal infections:
Vibrio cholerae (Cholera) Enterics (Salmonella, Shigella, E. coli) Campylobacter jejuni

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Gastroenteritis

Cholera
Causative agent: Vibrio cholerae High infectious dose
Bacteria sensitive to stomach acid Adheres to small intestine and multiply
Bacteria dont enter cells

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 Cholera toxin
Potent exotoxin Causes intestinal cells to rapidly pump out electrolytes Passive osmotic H2O loss follows Metabolic acidosis Shock

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 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

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Gastroenteritis

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

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Infects cells of large intestine and initiates intense inflammatory response Dead cells slough off Produces areas covered with pus and blood

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 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

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Travelers 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

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 Enterohemorrhagic E. coli
O157:H7 Produce potent Shiga-like toxins and type III secretion systems

Antimicrobials cause increase in toxin production

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Salmonellosis and Typhoid Fever

Causative agent: Salmonella enterica
2000 strains (serotypes) Typhimurium and Enteritidis commonly cause Salmonellosis Typhi and Paratyphi cause Typhoid Fever

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 Common intestinal flora of many animals Contaminated animal products are reservoir
Reptiles, eggs and undercooked poultry

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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 through intestinal cells into bloodstream

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 Typhoid fever is an enteric fever

Macrophages carry bacteria to liver, spleen, bone marrow and gallbladder Treated with ciprofloxacin or ampicillin Surgical removal of gallbladder

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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

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 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

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 Guillain-Barr Syndrome
Tingling of the feet leads to progressive paralysis of the legs, arms and rest of the body 40% of cases preceded by campylobacteriosis May be associated with autoimmune response
80% recover completely; 5% mortality with treatment

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Viral Gastroenteritis
Common causative agents:
Rotaviruses and Noroviruses Both naked RNA viruses

Wheel -like Rotaviruses

Star-like Noroviruses
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 Epidemology
Infect intestinal cells causing cell death Typically self-limiting Norovirus epidemics cause 90% of cases Rotaviruses responsible for 50% infant cases of serious diarrhea
600,000 worldwide annual fatalities Oral vaccine available

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Bacterial Food Intoxication

Staphylococcus aureus
Halotolerent; grows well in foods at room temp Associated with cafeterias and social functions

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 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

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Botulism
Causative agent:
Clostridium botulinum
Obligate anaerobic, Gram +, spore forming bacillus

Produce 7 different neurotoxins

One of most deadly toxins known

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 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

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 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

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 Epidemiology
Food borne botulism
Commercial sterilization Toxin destroyed by heating foods

Wound botulism
deep crushing wounds

Infant botulism
Inhalation or ingestion of spores Commonly associated with honey or juices
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 Prevention
Proper sterilization and sealing of canned food No honey or unpasteurized juices for infants!!

Treatment
Antitoxin Gastric washing and surgical removal of tissues Artificial respiration may be required Anti-microbials given to kill bacteria in infant and wound botulism

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