Chapter 17 Flashcards

1
Q

What is a true food poisoning?

A

Ingestion of a pre-formed toxin (no organism needed)
Faster acting (hours)
Survive cooking/heating

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2
Q

What is a food-associated infection?

A

Food is a vehicle for a pathogen

Slower onset of symptoms

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3
Q

How can a pathogen change fluid balance to cause GI disease?

A

Change the balance of water and electrolytes in the small bowel causing massive fluid secretion

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4
Q

How do cell destruction and inflammation occur to cause GI disease?

A

Invasion and/or cytotoxin production

Will lead to a fever

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5
Q

How does invasion cause GI disease?

A

Penetrates intestinal mucosa allowing the pathogen to spread and multiply outside of the bowel
Blood or pus found in feces

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6
Q

What is diarrhea?

A

The most common outcome of GI tract infections that increases fluid and electrolyte loss in the gut lumen (unformed or liquid faeces)

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7
Q

What does diarrhea allow?

A

Allows the host to get rid of the pathogen and the pathogen to disseminate

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8
Q

How does diarrhea differ in resource-rich and resource poor region?

A

Poor: Major cause of mortality in children
Rich: Usually mild and self-limiting except in very young, elderly and immunocompromised

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9
Q

How do we determine the cause of the diarrhea?

A

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

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10
Q

What is a common bacterial cause of diarrhea?

A

E. coli, most versatile, member of gut flora

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11
Q

What does Enteropathogenic E. coli (EPEC) cause?

A

Sporadic cases and outbreak of diarrhea in babies and young children
No toxin production

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12
Q

What are the virulence factors of EPEC?

A

Adhesions, bundle-forming pili and intimin to attach to epithelial cells and microvillus

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13
Q

What does Enterotoxigenic E. coli (ETEC) cause?

A

Most important cause of bacterial diarrhea in children

Presence of E. coli not necessarily important, plasmid is (Need lots to cause problems)

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14
Q

How does ETEC work?

A

Binds to receptors on the cell membrane of the small intestine and produces plasma encoded toxins (heat labile and stable)

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15
Q

How do the 2 plasmid encoded toxins of ETEC work?

A
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
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16
Q

Where is Enterohaemorrhagic E.coli (EHEC) found?

A

In the intestine of healthy cattle (uncooked ground beef, unpasteurized milk/juices, contaminated water, bean sprouts, celery)
“Hamburger disease”

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17
Q

How does EHEC work?

A

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)

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18
Q

What are some symptoms of EHEC?

A

Ulceration and bleeding of the large intestine causing bloody diarrhea
Destruction of RBC cause anemia (fatigue, weakness)
Low platelet count and sudden kidney damage

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19
Q

What is the ID50 of EHEC?

A

Very small, only takes a few to cause problems

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20
Q

What is the serotype of EHEC?

A

Serotype O157:H7

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21
Q

What are some complications of EHEC?

A
Hemorrhagic colitis (destruction of mucosa leading to hemorrhage and bloody diarrhea)
Hemolytic ureic syndrome (HUS-toxin in blood stream)
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22
Q

What may account for the kidney damage by EHEC?

A

Verotoxin receptors found on the renal epithelium

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23
Q

How does Enteroinvasive E. coli (EIEC) work?

A

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

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24
Q

What are the symptoms of EIEC?

A

Blood and mucous in the stool

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25
Q

How does enteroaggregative E. coli (EAEC) work?

A

Aggregation using plasmid-encoded fimbria

Toxins produced but role uncertain

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26
Q

How does EAEC appear on tissue culture cells?

A

Like stacked bricks

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27
Q

What does Diffuse-aggregative E.coli (DAEC) produce?

A

alpha-hemolysin and cytotoxic necrotizing factor

Role in diarrhea not well understood

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28
Q

How do we ID EHEC strain?

A

By probing for shiga toxin genes or proteins (use antibodies-ELISA)

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29
Q

How do we ID EIEC strain?

A

Look for the invasion of tissue culture cells or the presence of invasion associated genes

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30
Q

How do we treat diarrhea?

A

No antibiotics as this can cause more toxin to be released

Fluid and electrolyte replacement and prevention (clean water, pasteurization, proper cooking)

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31
Q

Why are antidiarrheal medications (immodium) bad?

A

Desensitizes the intestinal epithelium to the toxin, increasing the contact time with the intestinal wall which can increase disease severity

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32
Q

How do we treat HUS?

A

Urgent treatment with dialysis

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33
Q

What does Salmonella spp cause?

A

Gastroenteritis, food poisoning and enteric fever (S. typhi makes typhoid fever)

34
Q

Where does salmonella spp. come from?

A

Meat, poultry, eggs, dairy products, farmed fishes

Cross contamination with animals, food and humans, water

35
Q

What are the symptoms of salmonella spp. infection?

A

6-48 hours after ingestion nausea, vomiting and diarrhea occur, usually self-limiting

36
Q

What must be done with food handlers when they have a salmonella spp. infection?

A

Excluded from work until 3 fecal specimens are negative

May be excreted in feces for several weeks post infection

37
Q

What are the symptoms of enteric fever?

A

Initial: Headache, fever, abdominal tenderness, constipation

Diarrheal stage: Gallbladder and Peyer’s patches

38
Q

How does salmonellosis colonize in the body?

A

Hides in a vacuole in the host cell, divides, then hides in monocytes to travel in blood stream and cause systemic infection
Chronic colonization

39
Q

How do we diagnose salmonellosis?

A

Recover from blood and stools

40
Q

Where does salmonellosis colonize chronically?

A

In the gallbladder and biliary tree with no symptoms but still constantly shedding (Typhoid Mary)

41
Q

What is the most common cause of bacterial gastroenteritis?

A

Campylobacter
High ID50
Heat sensitive, invasive

42
Q

What are the symptoms of campylobacter infection?

A

Lasts 2-5 days
Diarrhea with blood and pus, painful (2-3 days)
Abdominal pain lasting longer
Self-limiting

43
Q

Where does campylobacter come from?

A

Poultry, contaminated meat, water and unpasteurized milk

44
Q

How is campylobacter identified?

A

By the S-shaped cells under the microscope

45
Q

How is campylobacter treated?

A

Using fluoroquinolone and macrolides

46
Q

What does vibrio cause?

A

Cholera (rapid dehydration by rice water stools), only infects humans

47
Q

Where is vibrio in endemic?

A

Southeast Asia, parts of south america and africa

48
Q

Where does vibrio come from?

A

Water environments, fish, shellfish

49
Q

What are rice water stools?

A

Stools free of RBCs and WBCs, pretty much just water

Diagnostic tool

50
Q

What is the pathogenesis of vibrio?

A

Mostly due to toxins that it only produces in the human gut (AB subunit, activating adenylate cyclase)

51
Q

What is vibrio sensitive to?

A

Stomach acid, need very very high number of cells to get sick

52
Q

What are the subsets of Shigella spp.?

A

S. sonnet (mild, most common in Canada)
S. flexneri
S. dysenteriae (most serious)
S. boydii

53
Q

What is the ID50 of shigellosis?

A

Very low (

54
Q

What toxins does shigella spp. produce?

A
Shiga toxin (similar to E.coli 0157)
Cytotoxic, enterotoxin, nerotoxic
55
Q

What is the pathogenesis of shigella spp.?

A

Enters an epithelial cell of the intestinal tract, multiplies inside, invades neighbouring cells. When released, epithelial cell is killed, forming an access
Kind of like salmonella

56
Q

What is a complication of shigellosis?

A

Damage to the epithelial and kidney cells causing HUS

57
Q

How can shigellosis be treated?

A

Mild is treated by rehydration

Severe needs antibiotics

58
Q

What is clostridium difficile?

A

A broad spectrum antibiotic-associated diarrhea (antibiotic resistant, when other microflora are killed, it takes over)
Most common cause of hospital acquired diarrhea
Spore formers, toxins

59
Q

What does clostridium difficile cause?

A

Mild-watery diarrhea to life-threatening toxic megacolon (surgical intervention)
Pseudomembranes forming pseudomembranous colitis (fibrin, neutrophils, mucin, cellular debris)

60
Q

What toxins does clostridium difficile produce?

A

Ted A (toxin A) and Ted B (toxin B) encoded by pathogenicity locus on chromosome together with negative and positive regulators of their expression

61
Q

What is the emergent strain of clostridium difficile?

A

C.difficile 027 produces more TedA and B due to deletion in regulatory gene (tcdC) that down regulates the production of two toxins

62
Q

How is clostridium difficile treated?

A
Antibiotics for a serious infection
Fecal transplant (successful, rejection rate due to genetic and gender link, need someone who hasn't been on antibiotics in 5 years, stomach acid is a problem)
63
Q

Does clostridium difficile ever go away?

A

Infection persists forever, most people never get their normal microflora back

64
Q

What are some common causative agents for food poisoning?

A

Staph aureus enterotoxin (8 types, heat stable, enzyme resistant), clostridium botulinum toxin

65
Q

How do S. aureus enterotoxins work?

A
It is a super antigen that binds to MHC class II molecules and cause T-cell stimulation
Body's reaction is much more aggressive
66
Q

What are the side effects of S. aureus enterotoxins?

A

Affects CNS, severe vomiting 3-6 hours after consumption, no diarrhea, complete recovery in 24 hours

67
Q

Where is listeria monocytogenes found?

A

Animals, the environment, undercooked food, unpasteurized food, soft cheese

68
Q

Who has an enhanced risk for listeriosis?

A

Pregnant women (can cross placenta) and immunocompromised individuals

69
Q

What is the ID50 of listeria monocytogenes?

A
70
Q

Is listeria monocytogenes susceptible to heat?

A

Yes, but survives and grows very well at room temperature (multiplies at 4 degrees)

71
Q

How does the virulence of listeria monocytogenes work?

A

Gets inside cells via endocytosis, forms actin tail and spreads from cell to cell via endocytosis without ever leaving host cells
Survives on macrophages

72
Q

What are the most common cause of gastroenteritis and diarrhea?

A

Viruses (rotavirus, norovirus), specific to human

Impact nutritional status and growth if contracted at young age

73
Q

What are rotaviruses?

A

Lt wheel naked viruses spread by oral-decal transmission

74
Q

What are the symptoms of rotavirus infection?

A

Vomiting, diarrhea (very high numbers-contagious), fever

Only 6-7 days

75
Q

How is rotavirus infection treated?

A

Fluid and salt replacement

Use clean, uncontaminated water

76
Q

How can rotavirus be prevented?

A

Using a vaccination

77
Q

What is a norovirus? Where does it commonly cause infection?

A

Calcivirus family, most common cause of food illness outbreaks
Schools, nursing homes, families, cruise ships

78
Q

What is the incubation period and rate of infection for norovirus?

A

24-48 hours

50% rate of infection (highly infectious)

79
Q

How can we determine if it is norovirus?

A

Unculturable so use an electron microscope or RT-PCR

80
Q

What is the 2nd largest cause of mortality and morbidity in the world?

A

GI tract infections