INFECTIOUS DISEASE OF THE GASTROINTESTINAL SYSTEM 2

I) MICRO QUESTIONS
→ (Review!) what is the difference b/w food poisoning & food intoxication
→ What are the most common symptoms of GI illness?
→ Why are dental caries included in a lecture about GI illness?
II) REVIEW
→ Infection vs. Poisoning
– Food poisoning (food intoxication)
* Bacteria don’t actively grow in the host
* Symptoms are triggered by ingested enterotoxins (a type of exotoxin)
» They may be emetic (trigger vomiting)
– Food infection
* Bacteria colonize host & may produce tissue damage or secrete toxins
–
Illness Foodborne Infection Food Poisoning
Description After ingestion, pathogen establishes infection in the host No infection: an ingested toxin causes the illness
symptoms
Common bacterial Agents Campylobacter jejuni, Shigella species, E. coli, Salmonella Toxins from Staphylococcus aureus, Bacillus cereus, and
species, and Listeria monocytogenes Clostridium perfringens
Symptom onset 1–5 days (or longer) after exposure 30 minutes to 6 hours after exposure
Signs & symptoms May include fever, headache, muscle aches, nausea, Most commonly nausea and vomiting and occasionally
diarrhea, abdominal pain diarrhea and abdominal pain
Recovery Days to weeks Usually w/in 24 hours; up to several days in severe cases

III) GI POISONING
→ Leading causes of food poisoning
– Food poisoning is often associated w/:
* Prepared foods that require a lot of handling
* Leaving foods at room temperature for extended periods
– Many enterotoxins are not affected by heat
* Cooking or reheating may kill bacteria, but won’t affect the enterotoxin
– Symptoms:
* Rapid onset (hours, not days)
* Causes inflammation of intestinal cells
* Prevents water absorption
* Leads to diarrhea & abdominal pain
→ Aspergillus Flavus
– Aflatoxin food poisoning
– Etiological agent
* Aspergillus flavus toxin (toxin producing fungi)
* Meat, eggs. & Milk may become contaminates after animals ingest contaminated feed
* Large outbreaks have occurred in India, Taiwan, &Uganda due to poorly stored food supplies
– Characteristics
* Grows on crops
* Corn & peanuts must be treated to remove toxin
→ Staphylococcus Aureus
– S. aureus food poisoning
* Linked to creamy salads (e.g., tuna, chicken), diary-based foods, poultry & meat products
* S. aureus can be part of normal nose & skin microbiota
 * Transmission is easy if hands are not washed before preparing food
* Leads to: nausea, vomiting, stomach cramps, diarrhea, dehydration, etc.
→ Bacillus Cereus
– B. cereus food poisoning
* Spore forming organism
* Cooking doesn’t always kill spores
* Food is left at room temperature:
» Allows spores to germinate
» Bacteria to actively grow
» Produce toxin (causes vomiting & diarrhea)
→ Clostridium Perfringens
– C. perfringens food poisoning
* Spore forming organism
* Commonly found in animal intestines & found on raw meat
* Most cases linked to gravy & meat products that are left too long @ room temperature
* Causes diarrhea & stomach cramps
→ Clostridium Botulinum
– Botulism
– Etiological agent
* Spore forming Clostridium Botulinum
* Cam be found in improperly made sausage
* Spores can be found in honey
– Mechanism of disease
* Exotoxin enters the blood & targets nerves
– Causes “flaccid paralysis” including issues w/ swallowing, breathing, & vision
* How does Botox work?
– Can be deadly!
IV) GI INFECTION (BACTERIA)
→ Campylobacter Jejuni
– #1 causative agent of GI illness in US (1.6 million ppl in US every year)
– Member of the poultry microbiome, transmits via undercooked poultry meat/juices
– Signs & symptoms
* Diarrhea
* Abdominal cramps
* Fever
* Nausea & vomiting
– Mechanism of disease
* Bacteria burrow through the mucosal layer of the intestine
* Migrate through intestinal epithelial cells
* Multiply beneath the epithelial layer
* Inflammatory response w/in 2-5 days
– Treatment & Prevention
* Thoroughly cook poultry
* Use different cutting board for meat & veggies
* Symptoms usually resolve w/in a week, not treatment required except symptomatic
→ Salmonella Enterica
– Overview
* Found in the microbiome of birds, some mammals, reptiles
* Contamination frequently found w/ LOTS of foods & from handling reptile pets
* Food & water can also be contaminated w/ feces of infected ppl or animals (e.g. eggs, pb (drip from the ceiling), chili peppers (transport))
 * Some strains cause GI illness, others typhoid fever (>2,600 strains known)
* Secretes a toxin that affects water transport in small & large intestine
– Signs & symptoms
* Appear w/in 1-2 days after consuming contaminated food or water
* Fever, abdominal cramps, vomiting, & diarrhea lasting 4-7 days
* May progress to dysentery
– Mechanism of disease
* Salmonella bacteria induce endocytosis in intestinal epithelial cells
* Enter by intestinal epithelium allows avoidance of the immune factors
* Salmonella can escape phagocytosis & multiply inside macrophages
→ Salmonella Serovar Typhi
– Typhoid fever from Typhoid toxin production (plasmid-borne virulence factor)
* Symptoms are similar, but include a Rose-colored spotted rash & serious abdominal pain that can last for weeks
* Vomiting can last for weeks
– Complications including intestinal rupture, internal bleeding, & shock make typhoid much more serious that regular salmonella
– Treatment & prevention
* Antibiotics (e.g., azithromycin
* Salmonella Typhi vaccine
→ Should I Eat that Cookie Dough?
– Infectious dose is high for S. enterica; consuming fewer than 1 million S. enterica cells does not produce disease in healthy persons
* BUT flour may also be infected w/ E. coli or even Shigella
* Children, elderly, immuno-compromised individuals have a lower infectious dose
– Poultry may carry bacteria such as Salmonella, which can contaminate the inside of eggs before the shells are formed. Egg shells may become contaminated with Salmonella from
poultry droppings (poop) or the area where they are laid.
* Should you eat homemade cookie dough? According to the CDC no!
→ E. Coli
– A normal resident of our intestines
– Can gain gene for producing shiga toxin (then called E. coli O157:H7) from Shigella bacteria
– Transmitted through undercooked beef or fruits & veggies tainted w/ cattle feces
– Fecal -> oral transmission also possible (daycare centers especially)
→ Shigella
– Overview
* Closely related to E. coli
* Produces shiga toxin, thought to be the most potent bacterial toxin.
* Shigella colonizes the large intestine
* Intestinal cells rupture, leading to dysentery (blood in the diarrhea)
* Can be fatal (20%) due to blood loss and dehydration
– Treatment generally limited to rehydration
– Spread is from person-to-person, fecal -> oral
– Poor sanitation, crowding and poor hygiene
– Children, prison populations, nursing homes, etc.
→ Cholera
– General
* Vibrio cholerae
» Fever and vomiting, followed by copious diarrhea
» Release cholera toxin
» Triggers intestinal epithelial cells to release electrolytes and water into the intestines
» Generates watery, starchy-colored diarrhea or “rice water” stool
* Patients lose 1 liter of fluid per hour
* Can lose 50% or more of body weight during a few days of illness
 * Death or recovery occurs within 48 hours
* Fatality rate of 55%
* Rates among top 7 causes of mortality in the world
– Vibrio cholerae
* Bacteria cause no direct damage
* Secreted toxin interferes with the ability of the intestines to reabsorb fluid
* V. cholerae can live in water and body fluids for long periods of time, especially in warm weather
* Outbreaks are often associated with wet weather, washing soil from outhouse areas to rivers and streams
* 4.3 million cases with 142,000 deaths per year worldwide
– Transmission
* Consuming raw shellfish (common in the US)
* Endemic in areas w/ water sanitation (e.g., Africa, SE Asia, Haiti)
* Large infectious dose required (~1,000,000 bacteria)
– Treatment
* Oral rehydration
* Antibiotics (e.g., doxycycline, azithromycin)
– Prevention
* Proper sewage & safe water management
* Travelers shouldn’t eat or drink anything that has not been boiled cooked, or peeled
* VaxchoraTM (approved in 2016)
– “Water Poisoning”: Cholera Epidemics
* Cholera has been a devastating disease for hundreds of years
* It has shaped human history (battels won & lost, medical science invented, etc.)
* In 2021: cholera outbreaks are still common following natural disasters, war, refugee movements
* A disease of poor sanitation
* This is different than hyperhydration (water intoxication) which is the fatal overconsumption of water. Usually this requires drinking more than one liter of water per hour for
several hours, or a very large amount of water in a short period of time.
→ Bacteria that Cause Diarrhea
– Clostridium difficile
* A normal resident of our large intestine
* One of the most common healthcare-associated infections
* Resistant to many/most antibiotics
* After course of antibiotics, most of the normal biota in the intestines are gone, C. diff remains & colonizes the area
– Treatment
* Probiotics to increase competition
* Fecal transplants (~90% effectiveness)
– Prevention
* Limit unnecessary antibiotic prescriptions
→ Clostridium difficile
– Symptoms:
* Mild cases have diarrhea & moderate abdominal pain
* Serious cases:
» Severe abdominal pain, fever, nausea, & abundant watery diarrhea
» May progress to dysentery Pus-filled pseudomembranous lesions
» Pseudomembranous colitis
» Toxic megacolon
V) GI INFECTION (VIRUSES)
→ Acute Viral Gastroenteritis
– Acute means “rapid onset”
– Also called the “winter vomiting bug”
 – It’s the most common form of foodborne illness & most common cause of GI illness in the US
– Usually caused by norovirus
– Norovirus is an RNA virus
– Rotavirus can also cause acute gastroenteritis, but mostly in children
* Can be very dangerous, but a vaccine is available
→ Norovirus
– Transmission
* Infectious does of 20 viral particles
* Fomite contact, contaminated food, contaminated water, feces & vomit spread the virus via the fecal-oral route
* Extremely hearty virus: can live on surfaces for several days, resists most cleaners & hand sanitizers, survives in
foods cooked up to 140 F
– Symptoms
* 12-48 hours incubation period
* Nausea, vomiting, diarrhea for 1-3 days
* Shed virus in stool for up to 2 weeks after infection
* Dehydration
– Treatment
* Most healthy individuals recover w/o medical intervention
* Some require fluid replacement treatment
→ Mumps
– Mumps is a vrial infection of the salivary glands
– Etiological agent
* Mumps virus
* RNA virus
– Transmission
* spreads though infected saliva
* Mumps virus enters the nose or mouth
* Replicates in the upper respiratory tract
* Released in saliva almost a week before symptoms develop
* Enters the bloodstream to infect salivary gland
– Signs & symptoms
* 12-25 days after infection
» Dry mouth fever
» Headache
» Fatigue
» Parotitis (inflammation of the parotid salivary glands)
– Treatment & prevention
* Most ppl w/ mumps recover completely w/in 2 weeks
* Measles, mumps, & rubella (MMR) vaccine