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 dont 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

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

 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
through intestinal cells into
bloodstream

 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

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

 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

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

Star-like Noroviruses

Wheel -like Rotaviruses

 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

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

 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

 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