Bacterial infections of the GI Tract Flashcards
H/o frequent vomiting early in the course of a GI tract disease indicates what usually?
Viral infection
High fever, lack of vomiting, abdominal pain with bowel movements, and the presence of gross blood and mucus in the stool suggest what type of cause?
Bacterial
What is the bacteria that is associated with improperly canned food?
Clostridium botulinum
Aerobic or anaerobic? Gram positive or negative? Cocci or bacillus? Spores? : Clostridium botulinum
Anaerobic
Gram positive
Rod
Spores
What is the MOA of botulinum toxin?
Inhibit the release of Ach from synaptic vesicles
Exotoxin or endotoxin: botulinum
Exotoxin
What are the ssx of botulinumism?
Descending weakness and paralysis
Dysphagia
Diplopia
Is the botulinum toxin heat stable or labile?
Will denature at 100 C for 15 minutes
What is the treatment for botulinum intoxication? What is the prognosis?
IV antitoxin (horse antibodies). This only binds to active toxin however, and thus it is a slow recovery
Aerobic or anaerobic? Gram positive or negative? Cocci or bacillus? Spores? : Clostridium difficile
Anaerobic
Gram Positive
Spore forming
Rod
What is the most common nosocomial cause of diarrhea?
Clostridium difficile
What abx is the most common cause of C.diff infections?
Cephaolsporins
True or false: C.diff does not invade intestinal tissue
True (well, rarely anyway)
What is the MOA of the exotoxin that C.diff produces?
Exotoxins A and B are enzymes that glycosylate a G protein involved in actin polymerization
What are the gross features of pseudomembranous colitis caused by C.diff?
White-yellow plaques
Is C.diff diarrhea bloody?
No
What is the treatment for C.diff?
Oral Metronidazole or vancomycin
Aerobic or anaerobic? Gram positive or negative? Cocci or bacillus? Spores? Lactose fermenter?: Shigella dysenteriae
Gram negative enteric rods
Non-lactose fermenting
What is McConkey agar used for? What are the results?
Tests for lactose fermentation
Color change = lactose fermenter
How do you differentiate Salmonella from Shigella?
Shigella:
- Produce no gas from fermentation
- Do NOT produce H2S gas
- They are non-motile
What type of diarrhea does shigella produce: bloody or not? Why?
Bloody– invasion of the intestinal epithelium causes blood and pus to form
What is the MOA of shigella? (does it produce a toxin? Does it invade cell walls)?
Produce a toxin and invade intestinal cell walls
What is the MOA of shigella toxin?
binds to ribosomes and halts transcription
What is the treatment for shigellosis?
IVF and lytes
If severe, fluoroquinolones (e.g. cipro)
Aerobic or anaerobic? Gram positive or negative? Cocci or bacillus? Motile? Lactose fermentation?: Salmonella?
Gram negative rods
NO lactose fermentation
Produce H2S
Motile
What are the two species of Salmonella that cause few GI symptoms?
S. Typhimurium
S. Enteritidis
What are the three types of Salmonella infections?
Enterocolitis
Enteric fever
Enteritidis
Which bacteria are not susceptible to HCl?
Shigella**
Campylobacter jejuni
Are S. Typhi or S. Enteritidis invasive?
If they cause disease, yes
Where does S.Typhi bacteria typically multiply? What can this lead to?
Peyer’s patches
Bacteremia d/t dispersion
What are the ssx of salmonella (besides Typhi)?
N/v
Abdominal pain
Diarrhea wwo blood
What are the symptoms of S.Typhi infection?
ILI
Splenomegaly
Rose spots on the abdomen
Rose spots on the abdomen in the setting of enterocolitis = ?
S. Typhi infection
What is the treatment for Salmonellosis?
Supportive
Ceftriaxone if severe
What organ typically holds Salmonella Typhi, and is the cause for the carrier state?
gallbladder
How do you differentiate E.Coli from salmonella dn shigella?
E.coli will ferment lactose
What happen with E.coli on MacConkey agar? What does this mean?
Turns the agar purple, meaning it ferments lactose
What is the gram stain, morphology, lactose fementation results, for E.coli? Aerobic or anaerobic?
Gram negative rod
Facultative anaerobe
Ferments lactose
What are the three antigens that E. Coli has?
O (in the cell wall)
H (flagella)
K (capsule)
What is the disease that enterotoxigenic E.Coli causes (ETEC)? MOA?
Traveler’s (watery) diarrhea
cholera-like toxin and local adherence
What is the disease that Enteroinvasive E.Coli causes (EIEC)? MOA?
Bloody diarrhea
Enters the intestinal epithelium, and destroys cells
What is the disease that Enteropathogenic E.Coli causes (EPEC)? MOA?
Watery diarrhea in infants.
Adhere to intestinal wall and cause loss of microvilli
What is the disease that Enterohemorrhagic E.Coli causes (EHEC)? MOA?
Bloody diarrhea
Produce shiga-like toxin
What is the cause of hemolytic uremic syndrome? What is this?
EHEC
Hemolysis followed by renal failure
What is the treatment for diarrhea caused by E.coli? What is the one strain that should not be given abx for? Why?
Supportive
EHEC d/t possibility to develop massive shia-like toxin release
Rice water stool = ?
Cholera
What is the gram stain and morphology of Vibrio Cholera?
Curved, gram negative rod
What is the MOA of Cholera (generally)?
Adherence to intestinal GI mucosa via pili (but no visible damage)
Cholera toxin
What is the MOA of cholera toxin?
AB protein that activates Gs, activating adenylate cyclase, and causing Cl channels to open and pump out Cl/water
How does the body overcome a cholera infection?
Shedding of the intestinal cell wall
What is the most common source of cholera infections?
Contaminated water or foods fertilized with human feces
What is the treatment for cholera?
Supportive
What is the gram stain and morphology of Campylobacter jejuni? Aerobic or anaerobic?
Curved, gram negative or
Microaerophilic
What are the ssx of campylobacter jejuni infection?
fever, n/v/ diarrhea and abdominal cramps
How do you diagnose Campylobacter Jejuni?
Stool culture in micoaerophilic conditions
What is the treatment for campylobacter?
Supportive or erythromycin/cipro if severe
What is the gram stain and morphology of helicobacter pylori? Aerobic?
Short, spiral, gram negative microaerophilic
What is the enzymes that allows H.Pylori to survive in the low pH of the stomach?
Urease
What is the route of transmission for H.pylori?
Fecal-oral route
How do you distinguish between H.Pylori and Campylobacter?
H.pylori has urease
What is the treatment for H.pylori?
PPI
Tetracycline
Clarithromycin
Why is there no fever with botulinumism?
Toxin is the causative agent, not bacteria
Will boiling of foods prevent botulinumism? Why or why not?
No– spores
What are the histological characteristics of C.Botulinum?
Gram negative Rods with spores at the end
What is the way to distinguish between diarrhea from other bacteria, and diarrhea caused by C.diff?
Toxins in the stool
What is the severe adverse reaction with Fluoroquinolones?
Tendon rupture/tendinitis
Match the MOA with the E.coli strain:
- Enterotoxin delivery
- Actin bundle pedestal formation
- Shiga toxin delivery
- Dissemination
- ETEC
- EPEC
- EIEC
- EHEC
What is the serotype of EHEC that causes diarrhea?
0157:H7
What is the major complication with EHEC?
Hemolytic uremic syndrome with abx use
Will heating food prevent cholera?
Yes– cholera toxin will denature
What is the odd thing about H.Pylori’s shape?
Multiple sheathed polar flagella
Corkscrew shape