Answers on Final exam Exam Test Flashcards

  Erosions of stomach or duodenum lining

*Food is not the causative agent

Helicobacter pylori

-Gram negative; Vibrio

- Multiple Polar knobbed flagella

- Abdominal Pain

-Nausea, vomiting (with or without blood), weight loss, bloody stool

- May lead to internal bleeding and shock (due to perforations of stomach or intestines)

- Signs and symptoms may worsen after you have eaten but again peptic ulcers are not caused by food

•Adhesions – surface proteins that help in attachment

•Urease enzyme neutralizes stomach acid

•Protein to inhibit acid production

•Enzyme to inhibit digestion by WBCs

–Inflammatory response and bacterial toxins causes decrease in mucus production

–Stomach lining not protected from acidic environment can lead to a Chronic infection

-Fecal/oral route (ingest something contaminated)

-flies

-20% of humans are asymptomatic carriers

-By assessing the damage done to the stomach lining

- by isolating a urease + Gram - vibrio

- change lifestyle to prevent risk factors

-stop drinking and eating spicy foods

- good hygiene to avoid fecal/oral contamination

- combined antibiotic treatment

-Medication to inhibit production of stomach acid

- surgery may be required if ulceration is extensive or perforation is occurs

Acute viral illness

- Attacks parotid salivary glands; massive swelling of glands (looks like neck is swollen)

- Virus reproduces in the URT and spreads to salivary glands where it destroys epithelium and then releases the virus causing inflammation

Enveloped ssRNA Rubulavirus

- Fever, loss of appetite, headache, parotitis (inflammation of the parotid glands), sore throat

- symptoms are self limiting and usually disappear in about a week

- symptoms are more severe past puberty and may cause orchitis (inflammation of the testes; increases the risk of testicular cancer) or meningitis

-Pregnant women often miscarriage

- Not so worried about the actual virus but the secondary risks

Humans are the only host

- spread through contact transmission, like droplets or fomites

- Peak infection time is from 1-2 days before swelling until swelling subsides

Immunization

-MMR vaccine

-Lifelong immunity

- alleviating symptoms (not with aspirin because its a viral disease)

- No effective antiviral treatment

Inflammation of stomach or intestines

- Inhibits nutrient absorption and excessive H2O and electrolyte loss

-Bacterial

-viral

-Parasites

- Poisening by microbial toxins (food borne intoxication)

*** will always be true for any type of gastroenteritis

- diarrhea, loss of appetite, abdominal cramps, nausea, vomiting and possible fever

- typically self-limiting

-severe form of gasteroenteritis

- Profuse diarrhea with mucus and blood (means damage is being done)

systemic with severe headaches, high fever, abscesses, intestinal rupture, shock and death

- Begins as gasteroenteritis, only turns into this if bacteria is successful at getting into the blood

Oral/fecal transmission

-occurs worldwide

- water is a common reservoir

-overcrowding and poor sanitation are risk factors

- animals may be a source of infection

-hand washing

- proper food handling and complete cooking

- Pasteurization of milk and juices

- Adequate sanitation

- safe water supplies and water treatment

-Rapid replacement of fluid and electrolytes (salt, chlorine, potassium, bicarbonate ions: all important for body to properly function)

- Fluid loss --> drop in blood pressure --> fatalities

- anti-nausea medication to help keep food down

- antimicrobial medications may be used in severe cases

- antidiarrheal medications are bad! Your body is trying to get rid of what is causing the problem

- normal pH is 7.4 - 7.6

3 groups of gram negative bacteria account for most bacterial intestinal infections

1. Vibro cholerae (cholera)

2. Enterics (Salmonella, shigella, e.coli) gram negative bacilli

3. campylobacter jejuni: leading cause in the US

Vibro cholerae, gram -

- most common organism in surface water. Can survive in salt or fresh water but become mobile in fresh water

- High infectious dose

- Bacteria sensitive to stomach acid: most bacteria usually die in the stomach so have to be exposed to a lot

- Adheres to small intestine and multiplies: produces an A toxin

- Bacteris doesn't enter cells; toxin does

          **Are more virulent in human host but normally survive in an alkaline pH

AB TOXIN - potent exotoxin

- B toxin binds to cell then A toxin enters cell

- A toxin causes intestinal cells to rapidly pump out electrolytes

- Passive osmotic H2O loss folows: water chases the electrolytes

- Metabolic acidosis

- Shock occurs because of dehydration

when body systems are too acidic because they loss their buffer systems/ bicarbonate ions

-Heavy loss of fluids

- "rice-water" stools: profuse, colorless, odorless stools flecked with mucus, looks like little peices of rice

- up to 20L of fluid lost per day

- May discharge 1 million bacteria per ml of feces lost

- untreated cases are potential fatal up to 24 hours

- fluid/electrolyte replacement

- tetracycline reduces toxin production

aka: bacilliary dysentery

- Shigella sp.: S. dysenteriae (most severe), S. flexneri, S. Boydii, S. sonnei

- Low infecting dose: 10 cells

- Bacteria, unlike cholera, is not sensitive to stomach acid

-fever and dysentery

- Infects cells of large intestine and initiates an intense inflammatory response

- Dead cells slough off and produces areas convered with pus and blood

All species produce enterotoxin

- Affects cells in intestines and type III secretion systems

- have a complex of about 20 proteins that embed themselves in channels of the intestines and facilitates movement of toxin into cell

- S. Dysenteriae produces powerful endotoxin

-Shiga- toxin: if toxin binds to neutrafils (white blood cells) it can enter blood and stop protein synthesis

         - bacteria alone cannot survive in blood

Ciprofloxacin, rifampin or azithromycin may reduce duration and infectivity

- primary treatment is fluid and electrolyte replacement

Escherichia coli (gram - bacilli, facultative anaerobes)

- have Multiple antigenic strains (O,H,K)

- Virulent strains have fimbriae, adhensions and multiple toxins

fecal coliform

- produce enterotoxins

- type III secretion systems

- typically are self limiting

- Test for them using MPN

More severe

 - O157:H7: associated with contaminated food; food poisoning

-Produce potent Shiga-like toxins and type III secretion systems

**Antimicrobials cause an increase in toxin production because it's gram - which is an endotoxin

Salmonella enterica

-2000 strains (serotypes) or genetic variations

- Typhimurium and Entertidis commonly cause Shigellosis

- Typhi and Paratyphi commonly cause Typhoid Fever, get into mucus membranes and sometimes in blood

-bacteria is a common intestinal flora of many animals

- contaminated animal products are reservoir

- Reptiles, eggs, and undercooked poultry

- 1/3 of all chicken carriers are contaminated with salmonella

- virulent strains tolerate stomach acids 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, gallbladder and bone marrow

treated with cyprofloxacin or ampicillin

- surgical removal of gallbladder

campylobacter jejuni

- leading cause of bacterial diarrhea in the United States

- Estimated 1 million cases annually with about 100 deaths

- Associated with poultry

- low infecting dose

virulent strains posses adhesions, cytotoxins and endotoxins

- Induce endocytosis in cells of intestines and initiate inflammation and bleeding lesions

- non-motile strains are avirulent (make sure that really means avirulent)

- usually mild and self-limiting

- severe cases are treated with ciprofloxacin or azithromycin

complication of campylobacteriosis, 40% of cases get this.

- immune system starts to attack body

tingling of the feet leads to progressive paralysis of the legs, arms and rest of the body

- may be associated with autoimmune response

- 80% of people recover completely and 5% die with treatment

– Rotaviruses and Noroviruses

– Both naked RNA viruses

– Both have glycoprotein spikes that help them attack to cells that line intestinal tract

–        Norovirus epidemics cause 90% of cases, norovirus effects infants especially and can be bad enough that they must be hospitalized

–        Rotaviruses responsible for 50% infant cases of serious diarrhea

-    600,000 worldwide annual fatalities

- infect intestinal cells causing cell death

- typically self limiting

- oral vaccine

- Electrolyte replacement

Staphylococcus aureus

- halotolerant; grows well in food at room temperature

associated with cafeterias and social functions

–        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

 5 heat stable enterotoxins: not killed by heat

–        100⁰ for up to 30 min will kill bacteria but

toxin will persist

-          do not treat with antibiotics because you are not treating bacterial infection, you are trying to get rid of a toxin

- self limiting

-clostridium botulinum

- a very resistant endospore

- obligate anaerobic, gram +, spore forming bacillus

- produce 7 different neurotoxins, one being the most deadly toxins known

-                      12 to 36 hours after interaction with toxin the symptoms will progress and be seen

–                                            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

Food-born botulism - progressive paralysis of all voluntary muscles due to toxin production

- wound botulism - similar symptoms, begins with colonization and then toxin is dumped into bloodstream

- Infant botulism - bacteria grows in the intestines, producing non-specific symptoms, in the US this is more common, but globally the other two are more common

infant begins to flounder, won't nurse, may a part of SIDS

food born, wound, infant

Proper sterilization and sealing of canned food

Prompt wound care

No honey or unpasteurized juices for infants, any child under 1.

Antitoxins: only going to neutralize circulating toxins

- Gastric washing and surgical removal or tissues which will dislodge bacteria

- Artificial respiration may be required

- anti-microbials given to kill bacteria in infant and wound botulism

- A mouse bioassay

take what they think is contaminated and inject a mouse to see if it dies, second mouse they inject a contaminated substance and botulism antitoxin to see if mouse doesn't die

Autoimmune disease

- alcohol/drug abuse, genetic disorders, viral infection

- 5 different types

- Hep A (HAV); HBV; HCV; HDV; HEV

- serum hepatitis, associated with pancreatic cancer

chronic hepatitis, major source of damage to the liver so badly that people need a liver transplant, spread through contaminated needles and spread of body fluids

Requires co-infection with HBV, does not have genetic material to make protective protein covering so on its own it cannot cause disease so it steals protein coverings from hepatitis B virus. Only problem when accompanied with hepatitis B is that people that have both are at a much greater risk for liver cancer

- Jaudice; yellowing of the skin and the whites of eye due to the buildup of beliruvin

-nausea

-vomiting

-fatigue

-fever

-weight loss

-Cirrhosis: liver replaced with fibrous nonfunctional tissue, liver failure, liver cancer (linked to hep B), and death

- most damages is caused by host defenses - from your own immune response trying to kill infected cells

-supportive care for symptoms

-anti-virals or interferon may help against HBV or HCV

- Passive immunotherapy

–        Avoiding exposure by practicing good hygiene and protected sex or abstinence

–        Vaccines are available against HAV and HBV

–        Avoid fecal contamination

–        Go over chart, know how its transmitted, if it will develop, what they are associated with

•         Most significant human pathogens worldwide

•         Few are intestinal pathogens

•         Transmitted by fecal to oral route

–        Fecal contaminated water

–        May be zoonotic

              - Giardia intestinalis

Flagellated, pear shaped

      -Two nuclei

    - Exists in two forms

A.   Feeding trophozoite

B.   Dormant cyst (Tough chitin shell)

–        Cyst infective stage: giant suction cup that allows it to attach to the digestive tract 

•         Resists stomach acid

•         Two trophozoits per cyst

–        Trophozoits attach to epithelium of small intestine with adhesive disk

–        In severe cases, may cover entire intestinal surface

–        Transmission usually fecal-oral route

–        May be zoonotic

•         Beavers, raccoons, muskrats, dogs, cats

•         Sometimes called “Beaver Fever” because beavers are such a prominent reservoir

–        Single stool can carry 300 million cysts

•         Cysts can survive in cold water up to 2 months

•         Chlorination often ineffective against cysts, normally the primary means of cleaning water but these are resistant, only way to remove them  is filtration

–        Filtration or boiling of water, boiling water for 10 minutes

–        Good hygiene practices

–        Sanitary disposal of feces: humans and animals

–        Safe sex

Diagnosed by cysts of trophozoites in stool

–        Fluid and electrolyte replacement

–        Metronidazole or quinocrine , both are eukaryotic pathogens and antiprotozoal drugs

–        Cryptosporidium parvum

•         Multiplies cells of small intestine

•         Apicomplexan : nonmotile but do have an apical complex that helps this cell penetrating into host cells

•         Exists in two forms

•         Acid fast oocyst: tough protective stage

•         Sporozoite: active feeding stage

–  Oocyst releases 4 bannana shaped sporozoites into small intestine

–  Sporozoites invade epithelium

•   Cause deformity in cells and villi (fingerlike projections that increase surface area for nutrient absorption)

•   Initiates inflammatory response

–  Water secretion increases & nutrient absorption decreases

–  Fever, headache, loss of appetite, nausea, abdominal cramps and profuse watery diarrhea

–  Can last for months

–  Usually self limiting and only life threatening in immunosuppressed people

–  May be life threatening in immunocompromised individuals

•   Hepatatis, pancreatitis

•   Individuals can expel organisms for up to 2 weeks after diarrhea ceases

–  Person-to-person spread occurs

–  Cysts can survive long periods in food and water

•   Resistant to chlorination but too small for most filters 

–  Zoonotic with a wide host range

–  Diagnosed by oocysts in stool

–  Careful monitoring of municipal water supplies

–  Pasteurization of drinks

–  Sanitary disposal of feces

–  Immunodeficient should avoid contact with animals and recreational water activities

- replacement of water and electrolytes

•   Entamoeba histolytica

–  Exists in two forms

•   Feeding trophozoite

•   Dormant cyst

–  Luminal –asymptomatic: what happens when you’re exposed to an averialent form, cannot attach because they do not have attachment  

–  Amebic dysentery – more severe; dysentery, colitis and ulceration of mucosal lining

–  Invasive extra-intestinal –necrotic lesions form in liver, lungs, spleen, kidneys and brain, when pathogens get in blood stream causing infection to become systemic

–  Transmission usually fecal-oral route

•   Cysts survive 1-2 weeks in environment

–  No animal reservoir, humans are the only carriers

•   10% of global population are carriers

–  3^rd leading cause of parasitic death 

•   50 million cases and 100,00 deaths annually

–  Disinfection, filtration and boiling of water

–  Sanitary disposal of feces, only human feces

–  Good hygiene practices

–  Safe sex

–  Oral rehydration

–  Metronidazole or iodoquinol 

–  Diagnosed by cysts or trophozoites in stool

-Macroscopic, multi-cellular parasitic worms

-cestods and nematodes

–  Flat, segmented, monoecious: have both male and female reproductive parts, they can impregnate themselves

–  Intestinal parasites that lack complete digestive system

–  Round, un-segmented, diecious, sexually dimorphic

–  Complete digestive system and protective cuticle

–  Cestodes: flat segmented worm

•   Taenia saginata – beef tapeworm

•   Taenia solium – pork tapeworm, its intermediate host of the pig

•   Usually asymptomatic

•   nausea, abdominal pain, weight loss, and diarrhea may occur

•   Worm may cause intestinal blockage

•   Individuals are sexually dimorphic

•   Highest incidence poor rural areaes

•   Inadequate sewage treatment

•   Humans live in close contact with livestock

–  Diagnosed by presence of proglottids in feces

relies on thorough cooking of meats and sewage treatments

–  Niclosamide or praziquantel: antihelminth drugs

–  May require surgical removal of worm of they get long enough, some can get meters long

•   diascious

–  Nematode

•   Enterobius vermicularis

•   Sexually dimorphic

•   perianal itching

- irritability

-decreased appetite all due to male and females worms in intestines where they steal nutrients

-they mate in intestines

-at night female will travel out of the body lay eggs around the anus and go back in causing the irritation

- Infections commonly occur in children

- most common parasitic worm in the US

- diagnosed based on microscopic id of eggs or presence of adult pinworms

strict personal hygiene

–  Pyrantel pamoate or mebendazole : both antihelminth drugs, two rounds of treatment at least two weeks apart, treat everyone in household