Bacterial Causes of Diarrhea – Flashcards
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Unlock answersInvasion |
- may not have any diarrhea or vomiting - dysentary may be present - fecal leukocytes present - blood in stool - fever |
Inflammatory gastroenteritis pathogens |
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Salmonella sp. (general, habitat) |
Gram -, rods, motile, facultative anaerobes, non-lactose fermenting
Habitat: - typhi = human - enteritidis and choleraesuis = intestines of animals |
Salmonella sp.: transmission |
Fecal-oral route animals to humans (Turtles) animal food products to humans |
Salmonella sp: O Ag |
somatic |
Salmonella sp: H Ag |
Flagellar Protein |
Salmonella sp: Vi Ag |
Capsular Polysaccharide |
Salmonella Pathogenesis |
-sensitive to killing by gastric acid -attach to gastric epithelial cells in sm. intestine and colon -> bacterial type III secretory system injects bacterial proteins into host cells -> internalization -> replication in vacuoles -> cell lysis -> enter mesenteric lymph nodes and blood stream -> fever, ab pain, diarrhea |
Type III Secretion |
used by Salmonella sp. -bacterial needle that injects effector proteins into host cell |
Salmonella enteritidis: Virulence |
-inflammatory diarrhea due to invasion of intestinal epithelial cells -controlled by vagocytic defenses -risk in immunocompromised for disseminated disease |
Salmonella typhi: pathogenesis |
-cause enteric fever (typhoid fever) -fever, nonproductive cough, bloody diarrhea, ab pain, rose spots on skin |
Salmonella typhi: Virulence |
-invasive intracellular pathogen -reaches blood stream (better than other Salmonella sp.) -little diarrhea -enteric fever -involvement of other organs |
Salmonella: Clinical manifestations - Enteritis |
- most common form of salmonellosis - symptoms occur 6 - 48 hrs after injestions
Symptoms last 2 days - 1 wk |
Salmonella: Clinical manifestations - septicemia |
- higher risk in pediatric, geriatric and immunocompromised - clinical presentation like all Gram (-) sepsis |
Salmonella: clinical manifestations - Enteric fever |
S. typhi = typhoid fever others = paratyphoid fever -bacteria pass through the gastric epithelial cells and are engulfed by macrophages
-Symptoms:
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Salmonella: detection |
Non-lactose fermenter = colorless on MacConkey agar
motile H2S+
enteritidis - isolated from stool typhi - isolated from stool OR blood
fewer rectal leukocytes than shigellosis |
Shigella Sp.: general, habitat, transmission |
General: Gram -, bacilli, non-motile, non-lactose fermenter resistant to stomach acids = only 10 - 20 bacilli needed to cause disease
Habitat: human and primate intestines invades and survives in cytoplasm
Transmission: fecal-oral, P2P
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Shigella sp: virulence |
-produces shiga toxin (exotoxin, cytotoxic to epithelial cell) -attach and penetrate GI epithelial cells and M cells (use Type III) -multiply intracellularly, spread to contiguous cells (use hemolysin to escape cell) -use host cell actin for transport |
Shigella sp: detection |
-isolation from stool -nonlactose fementer Distinctive features from Salmonella: -non-motile -H2S negative |
Shigellosis: clinical manifestations |
-incubation period 36 - 72 hrs -fever, cramping ab pain (both non specific) -dysentary 2 days later -watery diarrhea |
Shigellosis: treatment |
-usually self limited -prevent P2P spread -fluid and electrolyte replacement for severe cases -antidiarrheal compunds contraindicated (b/c they inhibit peristalsis = can't get rid of toxin) |
Campylobacter sp: general |
General: gram -, curved or comma shaped, microaerophilic, motile rods can suvive intracellularly in monocytes and intestinal epithelial cells -; tissue necrosis and cell death can travel to blood stream ; |
Campylobacter sp: habitat and transmission |
habitat: intestinal tract of animals ; transmission: -fecal-oral route -transmitted ny contraminated food; more common in summer |
Campylobacter sp: incidence |
leading cause of bacterial diarrheal illness in US ; most common cause in udnerdeveloped countries ; 3-5 days after ingestion; diseasse only if penetrates the mucouse layer and invades GI epithelial cells |
Campylobacter sp: virulence |
-flagella -adherence factors -heat labile toxin = watery diarrhea -ingestion by host cells = inflammatory colitis -can also produce shiga toxin -inflammatory and bloody diarrhea |
Campylobacter sp: clinical manifestations |
anywhere from 7 days to chronic infection ; periumbilical cramping, intense abdominal pain that mimics appendicitis, malaise, myalgias, headache, vomiting ; watery diarrhea = most common ; inflammatory bowel disease |
Campylobacter sp: detection |
Detection: -WBC in feces -isolation in stool: requires growth on Campy or Skirrow media ; |
Yersinia enterocolitica: general, habitat, transmission |
general: aerobic, gram (-), bacilli ; habitat: domestic and farm animals ; transmission: fecal-oral route |
Yersinia enterocolitica: pathogenesis |
invades mucosa of terminal ileum -; painful enlargement of mesenteric lymp nodes - mistaken for appendicitis - causes inflammatory and bloody diarrhea ; transmitted by contaminated meat products, mostly during winter (can grow at 4 degrees C) |
Yersinia enterocolitica: virulence and clinical manifestations |
virulence: -heat stable enterotoxin -; inflammatory and bloody diarrhea ; clinical: -febrile illness with abdominal pain -can mimic appendicitis -lasts 2 - 3 weeks -common in infants, occasional septicemia |
Yersinia enterocolitica: detection |
isolation from stool and blood |
Aeromonas sp. |
gram (-), motile, bacilli ; found in fresh, salt and chlorinated water habitats ; very resistant to temperatures and chemicals ; Aerolysin cytotoxic toxin (ACT) ; opportunistic pathogen in immune compromised |
Vibro sp: general |
small, curved, gram (-), bacilli, single flagellum |
V. cholerae: virulence, transmission |
virulence: -produces cholera toxin - activates adenylate cyclase to increase cAMP -; voluminous, watery diarrhea ; transmission: -contaminated water or food (shellfish or crabs) |
Vibro cholerae: pathogenesis |
-colonizes small bowel -acute illness due to enterotoxin production ;;; -severe form: rapid loss of liquid and electrolytes; hypovolemic shock, metabolic acidosis and death -acid sensitive = requires a lot to cause disease |
Cholera toxin (enterotoxin) |
- A-B type toxin - A increases adenylate cyclase activity -; increase in cAMP |
Vibro cholera: clinical manifestations |
-abrupt, watery diarrhea (rice water) -vomiting following diarrhea -cyanotic, sunken eyes, high voice, unobtainable BP, etc. all because of severe dehydration |
Vibrio cholera: diagnosis |
-rice water stools -stool culture on thiosulfate-citrate-bile salt-sucrose agar (TCBS); colonies are yellow, other Vibrio are green |
Vibrio parahaemolyticus: |
-hemolytic strains are most virulent -enterotoxin production -; moderate bowel inflammation; mild to moderately severe diarrhea -halophilic (salt-loving); grows in marine environments -found in raw or undercooked shellfish -colonizes small intestine |
Vibrio parahaemolyticus: Transmission, clinical manifestions, diagnosis |
Transmission: -ingestion of inadequately cooked seafood or sushi ; clinical: watery diarrhea, ab cramps, nausea, vomiting, bloody diarrhea (sometimes) ; diagnosis: green on TCBS agar |
Enterotoxigenic E. Coli (ETEC) |
-Non-invasive = do not see fecal WBC's -colonize sm. intestine -common cause of traveler's diarrhea -produce cholera-like (heat-labile) toxin and a heat-stable toxin -; both lead to watery diarrhea (secretion of Cl- -; osmotic diarrhea) -abrupt onset watery diarrhea, lasts less than 24 hrs after initiation of fluid replacement |
Enteropathogenic E. Coli (EPEC) |
-non-invasive = do not see WBC in stool -no known toxin -adheres to epithelial cells in Sm. intestine and disrupts microvilli (effacement) -type III secretory system ;; -makes its own receptor ;;;;;;; - when it binds to cell it forms pedestals -watery diarrhea with mild inflammation, infants ;6 m.o. |
Enteroaggregative E. Coli (EAggEC) |
-non-invasive = do not see WBC in stool 3 stages:
-may colonize sm. and lg. intestine -cause of a more persistent diarrhea |
Diagnosis and treatment of inflammatory E. coli infections |
Diagnosis: -isolation on MacConkey's Agar (like Vibro)(lactose fementer) Tx: fluid and electrolytes, antibiotics |
Enteroinvasive E. coli (EIEC) |
-similar pathogenesis as for Shigella infections -results in watery diarrhea and dysentery -sporadic outbreaks in infants and children |
Enterohemorrhagic E. coli (EHEC) |
-mostly infects lg. bowel -kidney damage due to Shiga toxin
Clinical manifestations: -Hemolytic colitis: severe crampy ab pain, watery diarrhea followed by bloody diarrhea, no fever -Hemolytic Uremic Syndrome: triad of acute renal failure, thrombocytopenia and microangiopathic hemolytic anemia |
Diagnosis and Treament of Invasive E. coli infections: EHEC |
Dx: -carbohydrate sorbitol must be included in the medium -inability to ferment sucrose -ELISA detection of Shiga Toxins 1 and 2 in stool
Tx: Avoid antibiotics |
Listeria monocytogenes: Listeriosis |
-usually mild diarrhea but systemic symptoms are prominent -pathogen can break into cytoplasm and divide -major risk is maternal infection during pregnancy -serious in immunocompromised |
Three most common causes of acute infectious diarrhea |
Salmonella, Shigella, Campylobacter |
E. coli: general |
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E. coli: Virulence Factors |
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E. coli: UTI strains |
UPEC
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Staphylococcus saprophyticus |
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Staphylococcus saprophyticus: Lab ID |
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Staphylococcus epidermidis |
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Staphylococcus epidermidis: pathogenesis and tx/px |
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Enterococci |
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Proteus mirabilis |
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Proteus mirabilis: virulence and lab ID |
Virulence Factors:
Lab ID:
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Enterobacter sp. |
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Pseudomonas aeruginosa |
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Psuedomonas aeruginosa: lab ID |
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Klebsiella sp. |
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Serratia marscescens |
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Candida albicans |
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