Академический Документы
Профессиональный Документы
Культура Документы
INFECTIOUS DIARRHEA
Two Basic Mechanisms
1.
2.
Toxigenic type
Bacteria release enterotoxins
Binds to Rc of the small intestine
Toxins disrupts physiology of epithelial
cells
Leads to increase electrolyte and water
secretion (secretory diarrhea)
Increase in volume with little or no blood
Invasive diarrhea
Invade wall of small or large intestine
Damage
of
mucosal
lining
and
underlying tissue layers
Pain in rectum, bloody stools, ulceration
of inner lining
Escherichia spp.
Enterobacteriaceae
Vibrio spp.
Campylobacter spp.
ENTEROBACTERIACEAE FAMILY
Escherichia spp.
Salmonella spp.
Shigella spp.
Characteristics
Spidey Transcriptions
Kingdom: Eubacteria
Domain: Bacteria
Phylum: Proteobacteria
Class: Gamma Proteobacteria
Order: Enterobacteriales
Family: Enterobacteriacea
Genus: Escherichia
Species: E. coli
Binomial name: Escherichia coli
Epidemiology
BACTERIAL DIARRHEA
Lipopolysaccharides (LPS)
Heat-stable
Composed of:
Somatic O polysaccharide
Core polysaccharide
Lipid a
Surface antigens:
O antigen polysaccharide part of LPS
H antigen flagellar antigen
K antigen polysaccharide capsular
antigen
Adhesins:
P pili
Colonization factor antigens (ETEC)
Aggregative adherence fimbriae
Bundle forming pili
Intimin
Ipa protein
Toxins:
Heat stable toxins
Heal labile toxins
Verotoxins (Shiga-like toxins)
Hemolysin cause tissue destruction
Endotoxin
Invasive capacity
1 jcc
E. coli serotypes
ENTEROINVASIVE E. coli
EAEC
Destruction of microvilli
Mucus production
Spidey Transcriptions
2 jcc
Shigella spp.
Kingdom: Bacteria
Phylum: Proteobacteria
Class: Gammaproteobacteria
Order: Enterobacteriales
Family: Enterobacteriacea
Genus: Shigella
Species: S. boydii, S. dysenteriae, S. flexneri, S.
sonnei
Binomial name: S. dysenteriae
Epidemiology
Laboratory Diagnosis
colonies
with
Biochemical Test
Morphology
O antigens
Endotoxin
Shiga toxin (S. dysenteriae, EIEC)
Exotoxin (acts as enterotoxin and
neurotoxin)
Disrupts protein synthesis; endothelial cell
damage
May cause HUS
Invasive property
Invasion plasmid antigens (surface proteins)
promote adherence and phagocytosis by
epithelial cells of intestinal mucosa)
S. dysenteriae
Treatment
SHIGELLA
Species
S. dysenteriae
S. flexneri (shigellosis in developing countries)
S. boydii
S. sonnei (industrial world)
Spidey Transcriptions
Oral-fecal route
Incubation: 1-2 days
Colonize small intestine
Invade and replicate in
colonic mucosa
Lower abdominal cramps, profuse watery diarrhea,
tenesmus, pus/mucus/bloody stools
Self-limiting
Acidosis
Dehydration
Death in elderly and
children
3 jcc
Laboratory Diagnosis
Specimen
Fresh stool
Mucus flecks
Rectal swab
Cultural/Growth Characteristics
Facultative anaerobes
MacConkey/EMB
Hektoen enteric agar, SS agar/XLD
medium
Convex, circular, transparent colonies
Non-lactose fermenter (except S. sonnei)
Non-motile
(-) lysine decarboxylase
(-) H2S
(+) acid not gas in butt
Salmonalla spp.
Kingdom: Bacteria
Phylum: Proteobacteria
Class: Gammaproteobacteria
Order: Enterobacteriales
Family: Enterobacteriacea
Genus: Salmonella
Species: S. bongori, S. enterica
Binomial name: S. enterica
Epidemiology
Biochemical Test
S. typhimurium
Treatment
Fluid replacement
Ciprofloxacin
Shigella cattc
Ampicillin
Tetracycline
TMP-SMX
Chloramphenicol
SALMONELLA
of
O and H antigens
Capsular (K) antigen
(Vi) antigen protects organism from action
of complement (protects from antibody
attack)
Pili adherence to epithelium
Endotoxin
Tolerant to acids in phagocytic vesicles
Can survive in macrophages
Pathogenesis: Enterocolitis
S. enteritidis (incubation: 8-48 hours)
Inflammatory response cause release of
prostaglandins
Species
S. enterica
Subspecies
Enterica
Salamae
Arizonae
Diarizonae
Houtinae
Indica
S. bongori
Serogroup
Subspecies enterica:
S. choleraesuis
S. typhi
S. paratyphi A
S. paratyphi B
S. enteritidis
Spidey Transcriptions
4 jcc
Treatment
S. typhi
Ingestion
Good sanitation
Hand washing
Screening of food handlers
Observe strict hygienic precautions
Food thoroughly cooked
Vaccination:
Oral live attenuated vaccine
Vi capsular polysaccharide vaccine
(intramuscularly)
VIBRIO
Species
rose spots
Laboratory Diagnosis
Widals Test
Spidey Transcriptions
Other Test
Slide agglutination test
Known sera + unknown culture
clumping
Serotyping: reference lab
Test kits
Tube agglutination test (Widals test)
V. cholerae (fecal-oral)
Serogroups
V. cholerae O1
El Tor
Classical
V. cholerae 0139
Kingdom: Bacteria
Phylum: Proteobacteria
Class: Gammaproteobacteria
Order: Vibrionales
Family: Vibrionaceae
Genus: Vibrio
Species: V. cholerae
Binomial name: V. cholerae
Epidemiology
consumption
of
contaminated
food
and
water,
gastroenteritis;
consumption
of
contaminated shellfish, crabs, shrimp
Infectious dose is high (108 -1010)
5 jcc
Morphology
Biochemical Test
2-4 m
Curved or comma shaped
Gram negative bacilli
(+) polar flagella
Aerobic rods
Virulence Factors
Flagella
Cholera toxin enterotoxin; hypersecretion
of electrolytes and water
Coregulated pilus adherence to mucosal
cells
Hemmaglutination protease induces
intestinal inflammation
Siderophores iron sequestration
Neuraminidase increase toxin receptors
Pathogenesis
Treatment
Improvement of sanitation
Isolation of patient and
excreta
disinfection
Acute gastroenteritis
Self-limiting
of
V. parahaemolyticus
No enterotoxins produced
BA; TCBS: green colonies
V. vulnificus
Death
Laboratory Diagnosis
CAMPYLOBACTER
Species
Spidey Transcriptions
C. jejuni
C. coli
C. upsaliense
C. fetus
Campylobacter spp.
Agglutination test
Kingdom: Bacteria
Phylum: Proteobacteria
Class: Epsilonproteobacteria
Order: Campylobacteriales
Family; Campylobacteriaceae
Genus: Campylobacter
Species: C. coli, C. concisus, C. curvus, C.
fetus, C. jejuni
Binomial name: C. jejuni
6 jcc
Epidemiology
Biochemical Test
Hippurate Test
Morphology
0.3-0.6 m
Gram negative rods with comma, S, gullwing shapes
Motile
Dark-field/phase contrast: darting motility
Single polar flagellum
Non-spore former
Lipopolysaccharides
Flagellar antigens
Enterotoxin
Cytotoxic enzymes
Adhesins
Motility
Specimen: stool
Cultural/growth characteristics:
Microaerophiles
5-10% carbon dioxide
Incubation temperature: 42C
Selective media: skirrows medium
(vancomycin, polymyxin B, trimethoprim)
Slow growing (2-3 days)
Gray, flat, irregular, mucoid, nonhemolytic
Watery and spreading or round and
convex
Spidey Transcriptions
7 jcc