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