Establishment of

Infectious Disease
in the Digestive
System
 Terminologies
Gastritis inflammation of the mucosal lining of the
stomach
Enteritis inflammation of the small intestines
Colitis inflammation of the colon (large intestines)
Gastroenteritis inflammation of the mucosal lining of the
stomach and intestine
Hepatitis inflammation of the liver
Dysentery low-volume, painful, bloody diarrhea
 Introduction
Several factors play important roles in the
causation of infectious disease in the digestive
system. The most crucial and important
impediment to infective agents is an intact
mucosal epithelium covering all parts of the
digestive system.
Signs and symptoms of infections in the gastrointestinal
tract are produced in several ways:
These mechanisms include:

01 Pharmacologic action

02 Local inflammation
03 Deep tissue invasion

04 Perforation
 Pharmacologic
01 action
Some bacteria produce toxins
which may alter normal
intestinal function without
causing lasting damage to their
target cells.
 Local
02 inflammation
Invasion of the alimentary tract by
microbes can lead to inflammation. In the
mouth, the gums are usually affected
causing periodontitis. In the intestines,
infections can cause inflammation that can
result to dysentery.
 Deep tissue
03 invasion
Certain organisms are
able to spread to
adjacent tissues and
enter the bloodstream.
04 Perforation
When the mucosal
epithelium is perforated, the
normal flora spills into
sterile areas and invades
deep tissues, often with
serious consequence.
04 Perforation
For example, perforation
of an inflamed
appendix can lead to
peritonitis.
MOUTH
Dental Caries (Tooth Decay)
 Unlike other exterior surfaces, the teeth are hard and do not shed
surface cells allowing accumulation of masses of microorganisms and
their products. These accumulations are called dental plaques and are
involved in the formation of dental caries or tooth decay. Older, calcified
deposits of plaque are called dental calculus or tartar.
The most important organism that causes
dental caries is Streptococcus mutans,
although other microorganisms may also be
involved (e.g., Actinomyces, Lactobacilli).
Streptococcus mutans is a
facultatively anaerobic,
gram-positive coccus
commonly found in the
human oral cavity and is a
significant contributor to
tooth decay.
Major etiologic agent of an
oral infection if present in
salivary substances from an
infected individual mixed
with food or drinks.
Preventive measures against the development of
dental caries include minimal ingestion of
sucrose, brushing, and flossing, regular
dental visits to remove plaque, and the use of
fluoride. The use of mouthwash may be
effective, with chlorhexidine being the most
effective.
Periodontal Disease
Periodontal disease is a term used to describe conditions
that are characterized by inflammation and degeneration of
structures that support the teeth.

Gingivitis is the reversible inflammation of the gingivae or

gums, characterized by bleeding of the gums while brushing
the teeth. This is due to overgrowth of supra-gingival plaque
causing irritation to the tissues of the gums. Organisms
involved are varied and include streptococci, actinomycetes,
and anaerobic gram-negative bacteria (Prevotella,
Bacteroides, and Fusobacterium nucleatum).
Periodontitis is a chronic gum disease that can cause bone
destruction and tooth loss. It generally causes little
discomfort. The gums are inflamed and bleed easily. As the
infection progresses, the bone and tissue that supports the
teeth are destroyed, leading to loosening and loss of teeth.
Numerous bacteria may be involved in the infection.
Acute necrotizing ulcerative gingivitis or Vincent's
disease or trench mouth is also another common serious
infection of the mouth. It is characterized by pain that
prevents normal chewing and may be accompanied by
bad breath or halitosis.
• Prevention and treatment
Good oral hygiene and professional
teeth cleaning. In certain cases, it will
also include the use of antibiotics and
periodontal surgery.
Oral Thrush
Oral Thrush
The organism that causes this condition is
Candida albicans, a fungus that is part of the
normal flora of the skin, mucous membranes, and
gastrointestinal tract. The conditions consist of
white patches adherent to the oral mucosa and
may occur on the tongue, lips, gums, or palate.
Candida albicans is an
opportunistic pathogenic
yeast that is a common
member of the human gut
flora. It can also survive
outside the human body. It
is detected in the
gastrointestinal tract and
mouth in 40–60% of
healthy adults.
Factors that predispose the development of oral thrush include
endocrine disturbance (eg. diabetes), prolonged intake of
antibiotics, malnutrition, malignancy, immunosuppression and
prolonged use of steroids.

Diagnosis can usually be made by inspection and confirmed by

examination of scraped material under the microscope
demonstrating the characteristic pseudobyphae.

Treatment consists primarily of correcting the predisposing factor

and avoiding unnecessary use of antibiotics. Topical antifungal
agents may be used. The drug of choice is nystatin.
Mumps
Mumps
it is a highly communicable disease characterized by
painful inflammation of the salivary glands.
This infection is caused by the mumps virus, a member
of the family Paramyxoviridae and there is only one
serotype. Humans are the natural hosts. The disease
occurs worldwide, affecting people who have not been
vaccinated before the age of 15. Lifelong immunity
occurs in persons who have had the disease.
 Mode of Transmission
Mumps virus is transmitted via respiratory
droplets.
 Clinical Findings
The virus infects salivary glands, with the parotid
glands predominantly infected. After an incubation
period of 18-21 days, the patient develops fever,
malaise, and anorexia followed by tender swelling of
the parotid glands and/or other salivary glands.
Involvement can be unilateral or bilateral. A
characteristic increase in parotid pain develops,
especially when drinking citrus juices. The disease is
benign and resolves spontaneously within a week.
 Complications
There are two o significant complications-
orchitis and meningitis. Orchitis is
inflammation of the testis. This complication is
significant if it occurs in post-pubertal males
and if the involvement is bilateral. Bilateral
orchitis can lead to sterility. Meningitis is
usually benign and self-limited.
 Laboratory Diagnosis
Diagnosis is usually based on clinical manifestations. Virus
isolation from saliva, spinal fluid, or urine can be done.
Measurement of antibody titers can also be made.

Treatment and Prevention

Treatment is mainly supportive. Prevention consists of
immunization with the live, attenuated vaccine (MMR) given at
15 months of age. Administration of immune globulin does not
prevent development of orchitis.
STOMACH
The major pathologies involving the stomach are inflammatory in
nature and consist of two conditions gastritis and peptic ulcer
disease. The predominant organism involved is Helicobacter
pylori, the most common cause of chronic gastritis and peptic
ulcers (gastric and duodenal).

It has two major virulence factors: rapid motility and urease

production. Its rapid motility enables it to penetrate the mucus
blanket lining the stomach. Urease produced by the organism
leads to production of large amounts of ammonia from urea that
leads to neutralization of gastric acid.
H. pylori
Previously known as
Campylobacter pylori, is
a gram-negative,
microaerophilic, spiral
bacterium usually found
in the stomach. A type of
bacteria that infects your
stomach.
 Clinical Findings
Gastritis and peptic ulcer disease are characterized by
recurrent pain in the upper abdomen, specifically
around the epigastric area. This may be complicated by
bleeding into the gastrointestinal tract. The acute
symptoms may last for less than one week until about
two weeks, however, the infection can persist for
years.
Laboratory Diagnosis
Gastric biopsy specimens can be
used for histologic examination.
Culture can also be done as well
as measurement of antibody
levels specific for H. pylori.
Treatment
Treatment involves triple therapy
with proton pump inhibitor
(omeprazole), macrolide
(clarithromycin) and amoxicillin
for 7 to 10 days. Proton pump
inhibitors directly inhibit H. pylori.
LIVER
Inflammation of the liver is termed hepatitis. Hepatitis can be
caused by varied organism such as bacteria, viruses, and
parasites. The most important causes of hepatitis are the
Hepatitis viruses. Cytomegalovirus, Epstein Barr virus, Herpes
Simplex virus, and Rubella virus. Enteroviruses, Dengue virus,
and the Yellow Fever virus are associated with sporadic hepatitis.
The clinical findings of hepatitis are virtually the same,
regardless of which hepatitis virus is the cause. Typical signs and
symptoms include fever, anorexia, nausea, vomiting, and
jaundice. Dark urine and pale feces are also observed. Most
cases resolve spontaneously in 2-4 weeks.
Hepatitis A Virus (HAV)
HAV causes infectious hepatitis. There is only
one serotype of Hepatitis A virus. It is transmitted
mainly by the fecal-oral route. Sexual
transmission is possible but rare. The virus
appears in the feces two weeks before the
appearance of symptoms. Children are the most
frequently infected, and outbreaks may occur.
The common source of outbreaks arises from
water and food contaminated with feces.
HAV has a short incubation period (3-4
weeks) and most patients with HAV
infection are asymptomatic. Fulminating
infection may occur in a small number of
patients. No chronic hepatitis or chronic
carrier state occurs. There is no
predisposition to hepatocellular
carcinoma or cancer of the liver.
 Diagnosis is confirmed by detection of
antibodies directed against the virus.
An increase in anti-HAV IgM antibody
1 signifies active infection while the
presence of anti-HAV IgG antibody
suggests previous infection.
Treatment is mainly supportive. Active immunization with a
vaccine containing inactivated HAV is available. Two doses are
given an initial dose followed by a booster dose 6-12 months
later. It is recommended for those travelling to developing
countries, children ages 2-18 years, sexually active individuals.
Passive immunization can be given to individuals exposed to
infected patients and is given 14 days after exposure. Other
preventive measures include observing proper hygiene such as
proper sewage disposal and thorough hand washing after
bowel movement. The virus can be inactivated by heating food
for at least 1 minute to above 85 °C and disinfecting surfaces.
Hepatitis B Virus (HBV)
HBV causes serum hepatitis. It is the
only DNA virus among the hepatitis
viruses. The three main modes of
transmission are through blood,
during sexual intercourse, and from
mother to newborn during birth or
breast feeding. The most efficient
method of transmitting the virus is
through injection into the
bloodstream. It is found worldwide.
Majority of patients are asymptomatic however present
symptoms are more severe than hepatitis A infection.
Hepatitis B can also present with extrahepatic
manifestations like polyarthritis, polyarteritis nodosa,
rashes and glomerulonephritis. Fulminant infection can
occur as well as chronic hepatitis which can lead to
cirrhosis and death. Some patients can become carriers,
especially infants born to hepatitis positive mothers.
HBV is also associated with the development of
hepatocellular carcinoma.
Diagnosis can be confirmed by means
of serology. Treatment is mainly
supportive although interferon-alpha
can be useful for the treatment of
chronic infection. Prevention involves
the use of either the vaccine or hyper-
immune globulin or both. All blood
for transfusion should be screened for
HBV.
 Hepatitis C Virus (HCV)
HCV causes parenteral hepatitis. It
is the predominant cause of non-A,
non-B (NANB) hepatitis worldwide
and the most common cause of
post-transfusion hepatitis among IV
drug abusers. Humans are the
reservoir for the virus and is
transmitted primarily via blood.
At present, injection drug use accounts for
almost all new HCV infections. Sexual
transmission and transmission from mother to
child may occur. In addition, HCV has been
found to occur as a co-infection with HIV.
Approximately 90% of patients with HIV
infection are also positive for HCV-RNA.
HCV primarily infects hepatocytes and remains inside the
hepatocytes throughout. As a result, chronic and
persistent hepatitis is the hallmark of infection. It
resembles HBV as far as the ensuing chronic liver disease,
cirrhosis, and the predisposition to hepatocellular
carcinoma are concerned. Alcoholism greatly enhances
the development of hepatocellular carcinoma in HCV-
infected individuals.
Diagnosis is confirmed by detecting
antibodies to HCV. A combination of
interferon alpha and ribavirin is the
treatment of choice for chronic
hepatitis C. Preventive measures
includes proper screening of blood
products prior to transfusion. Reducing
or completely avoiding consumption of
alcoholic beverages also reduces the
risk of developing hepatocellular
carcinoma and cirrhosis.
 Hepatitis D Virus (HDV/Delta Virus)
HDV causes delta hepatitis. It is an unusual virus in
that it is considered as a defective virus for it
cannot replicate on its own and can only do so in
cells also infected with HBV. As such, it is considered
as a viral parasite. It uses the surface antigen of HBV
as its envelope. It is therefore transmitted by the
same means as HBV.
HDV can occur as co-infection and superinfection. In co-
infection, the patient is infected with both HDV and HBV at
the same time. In a superinfection, a person previously
infected with HBV (carrier) becomes infected with HDV. Acute
hepatitis resulting from a co-infection is more severe than in
those infected with HBV alone. Hepatitis in chronic carriers of
HBV who become superinfected with HDV is more severe
with greater incidence of fulminating hepatitis, chronic
hepatitis, and liver failure.
Diagnosis rests on detection of either delta antigen or
antibody to delta antigen in the patient’s serum.
Administration of alpha interferon may minimize some
of the effects of chronic hepatitis, however, it does not
eradicate the chronic carrier state. Vaccination for
hepatitis B may prevent the occurrence of delta
infection because HDV cannot replicate unless HBV
infection also occurs.
 Hepatitis E Virus (HEV)
HEV is the major cause of enteric hepatitis.
It is transmitted purely through the fecal-oral
route. Clinical manifestations are similar to
hepatitis A, with the exception of a high
mortality rate in pregnant women. There is
no chronic hepatitis or a prolonged carrier
state. Diagnosis is made by excluding HAV
and other causes. There is no antiviral drug
or vaccine available to prevent infection.
 Hepatitis G Virus (HGV/GB Virus C)
HGV is not primarily hepatotropic. The virus
replicates within monocytes then finds its way
into the liver where it can cause a chronic type
of hepatitis. It is transmitted through sexual
intercourse and blood transfusion and may
occur as a co-infection with HIV. It has been
noted that patients co-infected with HIV and
HGV have lower mortality rate and have less
HIV in their blood than those infected with HIV
alone. In vitro studies have shown that HGV
may interfere with the replication of HIV.