Chapter 17 Flashcards
What is a true food poisoning?
Ingestion of a pre-formed toxin (no organism needed)
Faster acting (hours)
Survive cooking/heating
What is a food-associated infection?
Food is a vehicle for a pathogen
Slower onset of symptoms
How can a pathogen change fluid balance to cause GI disease?
Change the balance of water and electrolytes in the small bowel causing massive fluid secretion
How do cell destruction and inflammation occur to cause GI disease?
Invasion and/or cytotoxin production
Will lead to a fever
How does invasion cause GI disease?
Penetrates intestinal mucosa allowing the pathogen to spread and multiply outside of the bowel
Blood or pus found in feces
What is diarrhea?
The most common outcome of GI tract infections that increases fluid and electrolyte loss in the gut lumen (unformed or liquid faeces)
What does diarrhea allow?
Allows the host to get rid of the pathogen and the pathogen to disseminate
How does diarrhea differ in resource-rich and resource poor region?
Poor: Major cause of mortality in children
Rich: Usually mild and self-limiting except in very young, elderly and immunocompromised
How do we determine the cause of the diarrhea?
Generally difficult to identify based solely on symptoms (important in outbreaks)
Get patient history (food intake, travel)
Macroscopic and microscopic examination of feces for blood and pus
What is a common bacterial cause of diarrhea?
E. coli, most versatile, member of gut flora
What does Enteropathogenic E. coli (EPEC) cause?
Sporadic cases and outbreak of diarrhea in babies and young children
No toxin production
What are the virulence factors of EPEC?
Adhesions, bundle-forming pili and intimin to attach to epithelial cells and microvillus
What does Enterotoxigenic E. coli (ETEC) cause?
Most important cause of bacterial diarrhea in children
Presence of E. coli not necessarily important, plasmid is (Need lots to cause problems)
How does ETEC work?
Binds to receptors on the cell membrane of the small intestine and produces plasma encoded toxins (heat labile and stable)
How do the 2 plasmid encoded toxins of ETEC work?
Heat labile (LT) toxin increases cAMP, similar mode of action to cholera Heat stable (ST) toxin increases guanylate cyclase activity which increase cGMP and fluid secretion
Where is Enterohaemorrhagic E.coli (EHEC) found?
In the intestine of healthy cattle (uncooked ground beef, unpasteurized milk/juices, contaminated water, bean sprouts, celery)
“Hamburger disease”
How does EHEC work?
Invasive and makes toxins that damage the large intestine by inhibiting protein synthesis
Verotoxin I and II (VTEC) or “Shiga like toxin” (SLT-1 and SLT-2)
What are some symptoms of EHEC?
Ulceration and bleeding of the large intestine causing bloody diarrhea
Destruction of RBC cause anemia (fatigue, weakness)
Low platelet count and sudden kidney damage
What is the ID50 of EHEC?
Very small, only takes a few to cause problems
What is the serotype of EHEC?
Serotype O157:H7
What are some complications of EHEC?
Hemorrhagic colitis (destruction of mucosa leading to hemorrhage and bloody diarrhea) Hemolytic ureic syndrome (HUS-toxin in blood stream)
What may account for the kidney damage by EHEC?
Verotoxin receptors found on the renal epithelium
How does Enteroinvasive E. coli (EIEC) work?
Attach to the mucosa of the large intestine, invade the cells via endocytosis, multiply, spread to adjacent cells and cause tissue destruction, inflammation and ulceration
What are the symptoms of EIEC?
Blood and mucous in the stool
How does enteroaggregative E. coli (EAEC) work?
Aggregation using plasmid-encoded fimbria
Toxins produced but role uncertain
How does EAEC appear on tissue culture cells?
Like stacked bricks
What does Diffuse-aggregative E.coli (DAEC) produce?
alpha-hemolysin and cytotoxic necrotizing factor
Role in diarrhea not well understood
How do we ID EHEC strain?
By probing for shiga toxin genes or proteins (use antibodies-ELISA)
How do we ID EIEC strain?
Look for the invasion of tissue culture cells or the presence of invasion associated genes
How do we treat diarrhea?
No antibiotics as this can cause more toxin to be released
Fluid and electrolyte replacement and prevention (clean water, pasteurization, proper cooking)
Why are antidiarrheal medications (immodium) bad?
Desensitizes the intestinal epithelium to the toxin, increasing the contact time with the intestinal wall which can increase disease severity
How do we treat HUS?
Urgent treatment with dialysis