VIRAL INFECTIONS OF THE

GASTROINTESTINAL TRACT

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

 Viral gastroenteritis
• Also called Viral Enteritis and
Viral Diarrhea
• Symptoms include nausea,
vomiting, diarrhea, abdominal
pain, myalgia, headache,
malaise, and low-grade fever
• Most often a self-limiting
disease lasting 24 to 48 hours

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

 Viral gastroenteritis
Pathogen Enteric adenovirus, astrovirus, calicivirus,
rotavirus
Reservoir Infected persons
Contaminated water and shellfish
Mode of transmission Fecal-oral route

Laboratory diagnosis Electron microscopic examination of stool

specimens
Immunodiagnostic or molecular procedures

Patient care Use standard precautions for hospitalized patients

Add contact precautions for diapered or
incontinent patients

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Most Common Types of Viral Hepatitis
• Type A Hepatitis (HAV Infection, • Type C Hepatitis (HCV Infection,
Infectious Hepatitis, Epidemic Non-A Non-B Hepatitis)
Hepatitis)
– Hepatitis C virus (HCV)
– Hepatitis A virus (HAV)
– Primarily parenterally
– Fecal-oral transmission transmitted; rarely sexually
• Type B Hepatitis (HBV Infection, • Type D Hepatitis (HDV Infection,
Serum Hepatitis) Delta Hepatitis)
– Hepatitis B virus (HBV) – Hepatitis D virus (HDV,
delta virus); coinfection
– Sexual transmission or witn HBV is necessary
household contact with an
infected person; injected – Exposure to infected blood
drug use; tattooing; and body fluids, etc.
needlesticks

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Most Common Types of Viral Hepatitis

• Type E Hepatitis
– Hepatitis E virus (HEV)
– Fecal-oral transmission; primarily fecally
contaminated drinking water; also person-to-person
• Type G Hepatitis
– Hepatitis G virus (HGV)
– Parenteral transmission

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Bacterial Infections of the GI Tract
• Bacterial Gastritis and Ulcers
– Helicobacter pylori, a curved, microaerophilic, capnophilic,
Gram - bacillus
– Transmission occurs via infected humans; probably by
ingestion; presumed to be either oral-oral or fecal-oral
• Campylobacter Enteritis
– Campylobacter jejuni (less common, C. coli), curved, S-
shaped or spiral Gram - bacillus
– Transmission occurs via animals, including poultry, cattle,
sheep, swine, rodents, birds, kittens, puppies, and other
pets
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Bacterial Infections of the GI Tract, cont.
• Cholera
– Certain biotypes of Vibrio cholerae serogroup 01, curved,
Gram - bacillus that secretes enterotoxin
– Transmission occurs via infected humans and aquatic
reservoirs; fecal-oral route
• Salmonellosis
– Members of the family Enterobacteriaceae, Gram - bacilli
that invade intestinal cells, release endotoxin, and produce
cytotoxins and enterotoxins
– Transmission occurs via domestic and wild animals;
contaminated food, fecal-oral, food handlers,
contaminated water

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Bacterial Infections of the GI Tract, cont.
• Typhoid Fever (Enteric Fever)
– Salmonella typhi, a Gram - bacillus that releases
endotoxin and produce exotoxins
– Transmission occurs via infected humans for typhoid
and paratyphoid; some people become carriers after
infection (e.g., “Typhoid Mary”)
• Shigellosis (Bacillary Dysentery)
– Shigella dysenteriae, S. flexneri, S. boydii, and S.
sonnei; nonmotile, Gram - bacilli, members of the
family Enterobacteriaceae
– Transmission occurs via infected humans

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Enterovirulent Escherichia coli
• Enterohemorrhagic E. coli (EHEC) Diarrhea
– Escherichia coli O157:H7 is most commonly involved;
others include O26:H11, O111:H8, and O104H21;
Gram - bacillus that produces potent cytotoxins
– Transmission occurs via cattle feces; also infected
humans, fecal-oral route
• Enterotoxigenic E. coli (ETEC) Diarrhea (Traveler’s
Diarrhea)
– Many different serotypes of enterotoxigenic E. coli
– Transmission is via infected humans, fecal-oral route

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

BACTERIAL INFECTIONS
OF THE
GASTROINTESTINAL
TRACT
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Gastritis, gastric and duodenal ulcers
• Gastritis is suspected when
a person has upper
abdominal pain with nausea
or heartburn
• Gastric ulcers: pain,
bloating, nausea, vomiting
after eating
• Duodenal ulcers: gnawing,
burning, aching, mild to
moderate pain just below
the breastbone

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Gastritis, gastric and duodenal ulcers
Pathogen Helicobacter pylori

Reservoir Infected humans

Mode of transmission Ingestion, presumed to be either oral-oral or

fecal-oral transmission

Laboratory diagnosis Staining and culturing of gastric and duodenal

biopsy specimens
Immunodiagnostic and molecular diagnostic
procedures
Patient care Use standard precautions for hospitalized
patients

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Cholera

• An acute, bacterial
diarrheal disease with
profuse watery stools,
occasional vomiting,
and rapid dehydration

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Cholera
Pathogen Vibrio cholerae

Reservoir Infected humans

Aquatic reservoirs
Mode of transmission Fecal-oral route
Contact with feces or vomitus
Ingestion of fecally contaminated food and water
Mechanical transmission by flies
Laboratory diagnosis Isolation on culture media

Patient care Use standard precautions for hospitalized

patients. Add contact precautions for diapered or
incontinent patients

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Typhoid fever (Enteric fever)

• A systemic bacterial
disease with fever,
severe headache,
malaise, anorexia, rash,
nonproductive cough,
and constipation

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Typhoid fever (Enteric fever)
Pathogen Salmonella typhi

Reservoir Infected humans

Mode of transmission Fecal-oral route

Food or water contaminated by feces or urine
Mechanical transmission by flies

Laboratory diagnosis Isolation of microorganism from blood, urine,

feces, or bone marrow
Immunodiagnostic procedures
Patient care Use standard precautions for hospitalized
patients. Add contact precautions for diapered or
incontinent patients

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Shigellosis (Bacillary dysentery)

• An acute, bacterial
infection of the lining of
the small and large
intestines, producing
diarrhea with blood,
mucus, and pus

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Shigellosis (Bacillary dysentery)
Pathogen Shigella dysenteriae, S. flexneri, S. boydii, S.
soneii
Reservoir Infected humans

Mode of transmission Direct or indirect fecal-oral transmission, fecally

contaminated hands and fingernails, fecally
contaminated food, water, milk
Mechanical transmission by flies
Laboratory diagnosis Isolation on culture media

Patient care Use standard precautions for hospitalized

patients. Add contact precautions for diapered or
incontinent patients

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Clostridium difficile-associated diseases

• Major cause of
conditions known as
antibiotic-associated
diarrhea

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Clostridium difficile-associated diseases
Pathogen Clostridium difficile

Reservoir Humans (member of the indigenous microbiota)

Mode of transmission

Laboratory diagnosis Commercial enzyme immunoassay

Patient care Use contact precautions for the duration of the

illness

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Protozoal Infections of the Gastrointestinal Tract
MODE OF
DISEASE ETIOLOGIC AGENT
TRANSMISSION
Humans; fecally

Amebiasis Entamoeba histolytica contaminated food or

water
Pigs; food or water

Balantidiasis Balantidium coli contaminated with

pig feces
Infected humans,
Cryptosporidium
Cryptosporidiosis cattle and other
parvum
domesticated animals
Cyclospora Fecally contaminated
Cyclosporiasis
cayetanensis water and produce
Humans and infected
Giardiasis Giardia lamblia
animals
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Three Protozoal Infections of the GI Tract

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Giardia lamblia
trophozoite, 10-20 µm long
by 5-15 µm wide

The trophozoite resembles

a face; the 2 nuclei look
like eyes; it has been
described as resembling
an owl face, a clown face,
and an old man with
glasses

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Helminths

• The word helminth means parasitic worm

– Helminths are multicellular, eucaryotic organisms; 2
major divisions: (1) round worms or nematodes, and
(2) flatworms or Platyhelminthes. The flatworms are
further divided into tapeworms (cestodes) and flukes
(trematodes).
– The helminth life cycle has 3 stages: egg, larva, and
the adult worm.
– Helminth infections are primarily acquired by
ingesting the larval stage; in some helminth
diseases, larvae enter by penetration of the skin.
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Helminth Infections of Humans
LOCATION HELMINTH DISEASE CAUSE

Skin Onchocerciasis Onchocerca volvulus

Muscle/Subcutaneous Trichinosis Trichinella spiralis

Tissue Dracunculiasis Dracunculus medinensis
Onchocerciasis O. volvulus
Eyes
Loiasis Loa loa

Respiratory System Paragonimiasis Paragonimus westermani

Wucheria bancrofti/
Filariasis
Circulatory System Brugia malayi
Schistosomiasis
Schistosoma spp.
Taenia solium (cysts)
Cysticercosis
Central Nervous System Echinococcus granulosis or
Hydatid cyst disease
Echinococcus multilocularis
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Helminth Infections of the GI Tract
• Ascariasis – Ascaris lumbricoides • Dwarf tapeworm – Hymenolepis
(N) nana (C)
• Hookworm infection – • Fish tapeworm –
Ancylostoma duodenale or Diphyllobothrium latum (C)
Necator americanus (N)
• Pork tapeworm – Taenia solium
• Pinworm – Enterobius (C)
vermicularis (N)
• Rat tapeworm – Hymenolepis
• Whipworm – Trichuris trichiura diminuta (C)
(N)
• Fasciolopsiasis – Fasciolopsis
• Strongyloidiasis – Strongyloides buski (T)
stercoralis (N)
• Fascioliasis – Fasciola hepatica
• Beef tapeworm – Taenia (T)
saginata (C)
• Clonorchiasis – Clonorchis
• Dog tapeworm – Dipylidium sinensis (T)
caninum (C)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Medically Important Arthropods
• 3 classes of arthropods studied in Parasitology courses:
– Insects (e.g., lice, fleas, mosquitoes)
– Arachnids (e.g., mites and ticks)
– Crustaceans (e.g., crabs, crayfish, and certain
Cyclops species)
• Arthropods serve as mechanical or biologic vectors in the
transmission of certain infectious diseases.
– Mechanical vectors pick up a parasite at point A and
drop it off at point B.
– Biological vectors harbor the parasite in their body,
where the parasite matures and/or multiplies.

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Ways in Which Arthropods May Be
Involved in Human Diseases
TYPE OF INVOLVEMENT EXAMPLE(S)

Scabies, a disease in which microscopic

The arthropod may actually be the cause
mites live in subcutaneous tunnels and
of the disease.
cause intense itching
The arthropod may serve as the Flea in the life cycle of the dog
intermediate host in the life cycle of tapeworm; beetle in the life cycle of the
a parasite. rat tapeworm
The arthropod may serve as the
Female Anopheles mosquito in the life
definitive host in the life cycles of a
cycle of malarial parasites
parasite
The arthropod may serve as a vector Oriental rat flea in the transmission of
in the transmission of an infectious plague; tick in the transmission of Rocky
disease. Mountain spotted fever and Lyme disease

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Medically Important Arthropods, cont.

A. Dermacentor
andersoni, wood tick,
one of the tick vectors of
Rocky Mountain spotted
fever

B. Xenopsylla cheopis,
oriental rat flea, vector of
plague and endemic
typhus

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Medically Important Arthropods, cont.

C. Pediculus humanus,
human body louse; a
vector of epidemic typhus

D. Phthirus pubis, the

pubic or crab louse

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins