2023-11-20

Chapter 24: Digestive System Infections

Bacterial diseases of the upper digestive system

Dental carries (Cavities)

• Many different bacteria involved

• Most important: Streptococcus mutans

• Converts sugar into:

• Slime layer – sticks to teeth

• Lactic acid (fermentation) – degrades tooth enamel

Prevention: Brushing teeth

• Fluoride: Hardens tooth enamel to

make it resistant to acid.

Periodontal disease: Gum disease, gingivitis

• Plaque bacteria get trapped between teeth

• Enzymes produced degrade gum tissue and cause inflammation

• Gingivitis – inflammatory response: bleeding of the gums

Prevention:
• brushing and flossing
Treatment:

• In advanced cases: antibiotics, surgery.

Helicobacter pylori gastritis

• Responsible for most stomach ulcers

• Produces ammonia to combat stomach acidity

• Degrades stomach’s protective mucus

• Stomach acids then damage tissue

Treatment: Antibiotics in combination with medication to inhibit stomach acid
production.

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Viral Diseases of the Upper Digestive Tract

Oral Herpes Simplex – HSV-1
• Causes a latent infection
• Up to 90% infection rate - Often asymptomatic

• Approx. 1 in 3 will have recurrent Cold sores

• Can also cause disease on other parts of the body

• ex. Herpetic whitlow – herpes infection on the finger

Treatment: topical creams

with acylclovir
• Only effective on active
lesions

• Does not cure the latent

infection.

Mumps – Mumps virus

Transmission: Droplet contact
Symptoms: Fever, loss of appetite, headache
• Swelling of the salivary glands
• Generally a mild disease in childhood

• More severe symptoms in adulthood:

• In Men: Swelling of the testes, sterility
• In Women: Swelling of the ovaries, pelvic pain

• Increased likelihood of miscarriage

• In rare cases: viral meningitis, sudden onset deafness, death from
brain infection

Treatment: None

Prevention: Attenuated whole agent vaccine – part of MMRV.

Bacterial diseases of the Lower Digestive System

Common symptoms

• Gastroenteritis – inflammation of the

stomach and intestine

• Abdominal cramps, nausea, vomiting

• Diarrhea

• Dysentery – Severe diarrhea

accompanied by blood and mucus

Ingestion of toxins in food: Intoxication

• Very sudden appearance of symptoms,
rarely involves fever

Ingestion of bacteria:
• Food borne Infection

• Incubation period while pathogen

increases in number
• Often involves fever.

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Cholera – Vibrio cholerae

• Lives in brackish (salty) water à spread easily in freshwater

• Transmitted through fecal contamination of food and water

• Bacteria that survive passage through the stomach colonize the small
intestine
• Produce cholera toxin (an enterotoxin)
• Causes intestine to secrete water and
electrolytes

• Extreme watery diarrhea

• Up to 20 liters of fluids can be
lost per day!
• Causes shock, collapse, death
from dehydration
Treatment: Rehydration therapy (clean drinking water)

• Nearly 100% survival rate

Prevention: Sanitation and chlorinated drinking water.

Shigellosis – Shigella (close relative of E. coli)

• Transmitted through food and water
contaminated with human feces
• Bacteria multiply inside macrophages and
invade intestinal epithelial cells

• Inflammation and cell death causes

dysentery (bloody diarrhea)
• Some strains also produce Shiga toxin
• A cytotoxin that kills cells in small
blood vessels and kidneys
• Hemolytic uremic syndrome

Treatment: Antibiotics combined with

rehydration therapy
Prevention: Proper sanitation.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6794464/

E. coli Gastroenteritis
• Lives in the intestinal tract of mammals – indicator of fecal contamination

• Most strains are harmless (ie. Part of the normal microbiota)

• Some strains have virulence factors that allow them to cause disease

Enterotoxigenic E. coli – ETEC

• Produces an enterotoxin (cholera-like toxin) – watery diarrhea

• Self-limiting (traveller’s diarrhea) – treat with rehydration therapy

Enterohemorrhagic E. coli – EHEC (or STEC) – Ex. E. coli O157:H7

• Produce Shiga toxins. More severe symptoms compared to ETEC
• Inflammation of the colon – profuse bleeding (hemorrhaging)
• Severe bloody diarrhea
• Can affect the kidneys – hemolytic uremic syndrome

Treatment: antibiotics and rehydration therapy

• Antibiotic resistance is becoming a problem.

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Salmonellosis – Non-typhoidal Salmonella

Transmission: food contaminated with animal feces
• Bacteria use invasins to enter epithelial cells in the intestine
• Endotoxin causes inflammation

Symptoms: fever, nausea, abdominal pain, diarrhea

Treatment: Rehydration therapy (antibiotics may do more harm than good)

Typhoid fever – Salmonella Typhi

• Transmitted by human feces

• More virulent – systemic

infections
• Endotoxin can cause shock,
organ failure, death
Treatment:

• Bacteriostatic antibiotics.

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Clostridium difficile Infection – Clostridium difficile

• Extremely resistant to antibiotics
• Colonizes the large intestine only when the normal microbiota has
been disturbed
• Antibiotic associated diarrhea
• Commonly occurs as a nosocomial infection
• May cause inflammation of the colon – Pseudomembraneous colitis
Treatment:

1. More antibiotics
2. Probiotics

3. Fecal transplant
• Normal microbiota from feces of a
healthy donor colonizes the intestine
and outcompetes C. difficile
• Nearly 100% success rate.

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Viral diseases of the Lower Digestive System

Viral Gastroenteritis
• Enterovirus group: Rotaviruses, Norwalk virus
Symptoms: Low fever, diarrhea, vomiting – “Stomach flu”
• Self-resolving in about a week
Transmission: Fecal-oral route
• Frequent cause of epidemic diarrhea
Treatment: Rehydration therapy

Prevention:
• Proper hand-washing

• Vaccines exist against some

enteroviruses (but not all).

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Viral Diseases of the Liver

• Hepatitis – Inflammation of the liver
• caused by several different, unrelated viruses

Hepatitis A – Infectious hepatitis

• Spread by the fecal-oral route
• Causes an acute infection – self resolving in a
few months
Symptoms:
• Malaise, diarrhea, nausea
• Liver damage, jaundice (yellow skin and eyes)

Treatment: None
Prevention:
• Inactivated whole agent vaccine – given to those at risk

• Post exposure – passive immunization with pre-made antibodies.

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Hepatitis B – Serum hepatitis

• Transmitted by direct or indirect contact with body fluids (ex. blood,
semen)
• Most cases result in acute infection – self-resolving
• Some cases develop into chronic infection
• Viruses multiplying inside liver cells induce a cell-mediated response*
• Cell death can lead to cirrhosis – hardening of the liver

• Viral DNA is integrated into host cell genome as a provirus

• Can lead to liver cancer * https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4526720/

Treatment:
• No cure

• Treatment with antivirals to slow multiplication and prevent liver damage

Prevention:
• Subunit vaccine given to children and those at risk
• Avoiding contact with blood and other body fluids.

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Hepatitis C – Transfusion transmitted hepatitis

• Transmitted through indirect contact through fomites
• Ex. Syringes, tattoo and piercing equipment
• Delay of about 25 days between infection and detection

• Chronic infection – no apparent symptoms for about 20 years

• Eventually results in cirrhosis of the liver, liver cancer.

Prevention: No vaccine, avoid contact with contaminated fomites

Treatment: Combination of interferon* and antivirals can cure^ Hep C
• Current cost of treatment is around $80,000.

* https://www.mayoclinic.org/drugs-supplements/interferon-alfa-2b-injection-
route/side-effects/drg-20071328?p=1
^ https://www.who.int/news-room/fact-sheets/detail/hepatitis-c

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Protozoan diseases of the digestive system

Giardiasis (Beaver fever)
• The protozoan Giardia lamblia
• Transmitted by drinking water
contaminated with animal feces
• Indigestion, nausea, flatulence,
“explosive diarrhea”
Treatment: metronidazole

Cryptosporidiosis – Cryptosporidium
• Transmitted by drinking improperly treated water

• Resists chlorine disinfection, must be

removed using ozone or UV
• Fever, nausea, abdominal cramps, profuse
watery diarrhea
• Can be fatal in immunocompromised patients.

• Treatment: nitazoxanide

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