Bacterial Infections of the GI Tract 2 Flashcards
MacConkey Agar:
Purpose of test
Positive Test
Negative Test
- Testing for lactose fermentation
- Agar/colonies turning RED indicates postive test
- Agar/colonies staying WHITE indicates negative test
Indole Test:
Purpose
Postive Test
Negative Test
- Test for indole production (from tryptophan)
- Positve test: RED color change
- Negative test: no color change
Hydrogen Sulfite Test:
Purpose
Postive Test
Negative Test
Salmonella reaction
Shigella Reaction
- Purpose of test is to see if organism can reduce sulfur compounds to sulfides
- BLACK PRECIPITATE indicates positive test. The organism produced FeS
- No black precipitate indicates a NEGATIVE test
- Salmonella is (+)
- Shigella is (-)
Enteropathic E. Coli (EPEC)
- Gram stain
- Aerobic abilities
- Invasiveness
- Gram stain negative
- Facultative anaerobe
- Moderately invasive
Enteropathic E. Coli (EPEC)
- Primary symptom
- What causes the symptoms
- Vulnerable populations
- Timing (8, 16, 16+)
- Inflammatory or non-inflammatory
- Primary symptom is watery diarrhea
- Cause of watery diarrhea is from microvilli destruction
- Infants and children are primary vulnerable popluation (P for pediatrics)
- Typically 16+ hours before onset of symptoms
- Non-inflammatory bacteria
Enteropathic E. Coli:
- Explain steps of pathogenesis
Keywords: Tir, Type III, Bfpa, F-actin
- EPEC injects Tir protein via Type III secretion and Bfpa
- Tir binds with Intimin
- F-actin polymerization occurs
- Rearranged actin causes microvilli destruction
- Without villi there is no fluid absorption…watery diarrhea
Enteropathic E. Coli:
Toxin Production?
Diagnosis: culture tests (2) and why they suck
Actual diagnosis method
Treatment
- No toxin production. Just watery diarrhea
- EPEC can ferment lactose (+ MacConkey) and produce Indol (+ Indol). Not great methods for diagnosis because most people have commensal, lactose fermenting, Indol producing bacteria.
- PCR is best method for diagnosis
- Supportive treatment and antibiotics if necessary (usually not)
Enterotoxigenic E. Coli
- Gram Stain
- Arerobic abilties
- Invasiveness
- Gram stain negative
- Facultative anaerobe
- Non- invasinve
1 and 2 are the same as EPEC
Enterotoxigenic E. Coli
- Disease nickname and why
- Primary symptom
- Leading _ _ cause of _ _in _ _world
- “Travelers Diarrhea” because associated with travel to developing countries and ingestion of contaminated water or ice
- Primary symptom is watery diarrhea
- Leading bacterical cause of diarrhea in developing world
Enterotoxigenic E. Coli
- How does it adhere to intestinal epithelium?
- Toxins produced (2) and how they work
- Inflammatory or Non-inflammatory?
- Timing
- Uses fimbriae to adhere to epithelial cells
- Toxins: LT and ST. LT is heat liable toxin while ST is heat stable toxin. Both cause increases in cAMP which causes efflux of Cl, K, Water, Na, and HCO3 which causes diarrhea
- Non-inflammatory
- 16+ hours after ingestion before onset of symptoms
Enterotoxigenic E. Coli
- Primary method of diagnosis
- Less common method of diagnosis given available resources
- Treatment
- Primary method is clinical history, especially with travel to endemic country
- DNA probes to detect LT and ST encoding genes in samples and cultures. Requires a research or reference lab
- Treatment is supportive and rehydration
Salmonella spp
- Number of serotypes of salmonella enterica serovar
- Which salmonella causes typhoid?
- Name 3 non-typhoidal salmonellas (etc…)
- Over 2500 serotypes
- Salmonella enterica serovar Typhi causes typhoid
- SES cholerasuis
SES Enteritidis
*SES Typhimurium* (strange name but non-typhoidal)
Salmonella Typi
- Gram stain
- Aerobic ability
- Shape and movement
- Acid tolerance
- Intracellular or extracellular
- Adapted to humans or not so much?
- Gram negative
- Facultative anaerobe
- Rods…motile flagella
- Acid tolerant
- Intracellular pathogen
- Highly adapted to humans
Salmonella Typhi
- Reservoirs
- Transmission route
- Infectious dose
- Who’s awesome?
- Humans are only known reservoir
- Fecal-oral transmission route
- Fair amount of infecting bacteria (10^5-10^6)
- You’re awesome
Salmonella Typi:
- Incubation time
- Put these symptoms in correct progression: typhoid fever, colonization of gallbladder, rising fever over 3 days, reinfection of intestines, andfever with headache
- Are shedders of S. Typhi symptomatic?
- Incubation time of S. Typhi is about 13 days
- Fever with Headache
- Rising fever over 3 days
- Typhoid fever (like a 4 week fever)
- GI symptoms: chronic colonization of gallbladder then reinfection of intestines
- Shedders are not symptomatic (Typhoid Mary)
Salmonella Typhy
- S. typhi adheres to which two types of cells?
- Uses what type of secretion system?
- Explain the pathogenesis using: T3SS, ssps, membrane ruffling, uptake, and escape
- Fever is caused by what toxin?
- S. Typhi adheres to M cells (immune cells) and enterocytes
- Type III secretion system
- Type III secretion system injectes ssps (salmonella-secreted invasion proteins) into M cells.
- Membrane ruffling causes uptake in to M cell vacuoles.
- The SSPS escape the vacuole and are phagocytosed by macrophages
- Macrophages go to lymph nodes
- Salmonella escape macrophage into blood
- Final result is bacteremia
- Fever is caused by LPS (endotoxin)
Salmonella Typhi
- Diagnosis
- Which tests to use and results (3)
- Treatment (3 choices) and based on what
- Prevention (2)
- Diagnose via culture of stool and blood samples on selective media
- MacConkey/Lactose fermentation: negative, Indole: negative, Hydrogen Sulfite: positive
- Antibiotic therapy based on susceptibility profile. Can use Fluoroquinolone, trimethoprim-sulfamethoxazole, or broad spectrum cephlosporin
- Avoid sources of contamination (non-bottled water, ice, uncooked foods, and raw fruits and vegetables. Vaccine available but not very effective or useful
One more time…name 3 kinds of non-typhoidal salmonella…go!
Disease of bloodstream, intestines, or both?
- Salmonella enterica serovar Cholerasuis
- SES Enteritidis
- SES Typhimurium
Enteric diseases so no bloodstream…most of the time
Non-typhoidal Salmonella
- Gram stain
- Aerobic abilities
- Motility and shape
- Acid tolerance
- Intracellular or extracellular pathogen?
- Gram negative
- Facultative anaerobe
- Motile rods, flagellated
- Acid tolerant
- Intracellular pathogen
Non-typhoidal Salmonella
- Prevalent in developed or developing countries?
- Vulnerable populations
- Animal reservoirs?
- Transmission route
- Developed countries
- Children and elderly
- Numerous animal reservoirs which makes it different than typhoidal salmonella
- Fecal oral route. Human-Human transmission is unlikely
Non-typhoidal Salmonella
- Symptom onset
- Symptoms (4)
- Diarrhea attributes and duration
- Prevalence of fever
- Symptom onset is 6-48h post ingestion
- N/V/D and abd pain
- Persistent diarrhea for 3-4 days. Can be loose and watery to dysentery (bloody and purulent). Loose and watery is far more likely
- 50% of cases have fever
Non-typhoidal Salmonella
- Pathogenesis
- What happens after entry into macrophages
- Pathogenesis is very similar to salmonella typhi
1. Rapid killing of macrophages. Causes inflammatory response which keeps disease confined to intestines. This leads to profuse, watery diarrhea
2. Carriage in macrophage which only occurs in immunocompromised. Systemic dissemination occurs causing sepsis. Focal infections can cause osteomyelitis, endocarditis, and arthritis
Non-Typhoidal Salmonella
- Diagnosis: two good ways
- Treatment
- Vaccine
- Diagnose via serology or culture (negative lactose, positive hydrogen sulfite)
- Treatment for salmonella gastroenteritis is supportive with electrolyte replacement. Antibiotics are NOT recommeded because it enhances carrier state. Only approved to prevent sepsis
- No vaccine available
Campyloybacter jejuni
- Gram stain
- Shape
- Aerobic ability
- Animal reservoirs
- Invasiveness and location
- Gram negative
- Curved rod. “Seagull shaped”
- Microaerophilic
- Many animal reservoirs (turkeys and pets)
- Definitely invasive to jejunum, ilium, and colon