GIT INFEKSI

Screening Stools for Pathogens

• Because stools have numerous microbial flora,
efficient screening methods must be used to
recover any pathogens
• Enteric pathogens include Salmonella, Shigella,
Aeromonas, Campylobacter, Yersinia, Vibrio, and E.
coli 0157:H7
 Screening Stools for Pathogens
(cont’d)
• Most labs screen for Salmonella, Shigella, and
Campylobacter; many screen for E. coli 0157:H7
• Fecal pathogens are generally lactose-negative
(although Proteus, Providencia, Serratia,
Citrobacter and Pseudomonas are also lactose-
negative)
 Staphylococcal Food Toxin
• S/S: Vomiting, severe cramping, low grade fever, diarrhea (no
blood in stool)
• Incubation: VERY short – 30 minutes to a few hours.
• Complications: None, spontaneous recovery
• Diagnosis: No specific test available. Clinical dx.
 Staphylococcal Food Toxin
• Treatment: Supportive – rest, hydration, compazine or other antiemetic
for persistent vomiting
• Origin: Toxin producing S. aureus strains, usually from human skin,
inoculate food, multiply at room temp. Toxins not destroyed by
reheating.
• Other toxin producing bacteria: Clostridium perfringens, Bacillus cereus.
 Staphylococcal Food Toxin
• Prevention
– Decrease food handling
– Do not allow foods to sit at room temp. for long periods
– Glove use by food handlers
– Exclude persons from food handling when obvious skin infections are
present.
Vibrio cholera

• Gram negative bacteria,

• comma shaped, arrow shaped
• Highly motile,
• facultative anaerobic,
• curved rods with one or more
flagella
• Non-invasive, remains in
intestinal tract
 V. cholera Pathogenesis
• Heat labile enterotoxin (MW) of 84,000 consisting A and B.
• Enterotoxin  increased cAMP  hypersecretion of water and
electrolytes  increased sodium dependent chloride secretion
 absorption of sodium and chloride by the microvilli is
inhibited
• Electrolyte rich diarrhea (20 – 30 L/day)
• Dehydration, shock, acidosis, and death
• Rice stool diarrhea
 Treatment

Antibiotics = not necessary, but would hasten organism clearance.

Macrolides (erythromycin) and azithromycin, tetracylcine or doxycycline.
Summary of bacterial gastroenteritis
 Viral Gastroenteritis
• Most common cause of infectious diarrhea in US
• Infect epithelium of small intestine
• Diarrhea is watery
• WBC’s and visible blood are rare
• 4 categories: Rotavirus, Claicivirus (norovirus), Astroviurs,
Enteric Adenovirus.
 Rotavirus
• Most common cause of diarrhea in young children
• Highly contagious: fecal-oral.
• Incubation 1-3 days, lasts 4-8 days
• Dehydration and hospitalization common in young children
• Diagnose by EIA antigen in stool
• Treat with oral rehydration or IV
• Oral vaccine now available (controversial)
 Calcivirus
• Infect older children and adults
• Nonspecific, self-limiting
• Large water-borne and food-borne outbreaks occur, fecal-oral
• Incubation 24-48 hrs, lasts 12-60 hrs
• No commercial tests to diagnose
• Treatment supportive (oral rehydration)
Viral causes
Gastroenteritis virus vs bacterial