GI Tract Infections Flashcards

You may prefer our related Brainscape-certified flashcards:
1
Q

What are GI infections?

A

Gastrointestinal infections are viral, bacterial or parasiticinfections that cause gastroenteritis, an inflammation of thegastrointestinal tract involving both the stomach and the smallintestine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the GI tract?

A

Begins at the oral cavity, the mouth and ends at the anus.

  • A diverse community of microorganisms comprise and define theintestinal microbiota.
  • The intestinal microbiota contributes to maintaining stability andpreventing overgrowth or infection with pathogenic bacteria.
  • Disruption of this stability results in susceptibility to infection.
  • Ingestion of pathogens can cause many different infections
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the bodies defence mechanism?

A

Mechanical movement (peristalsis) throughout GI tract.
● Mucus/bile – physical barrier preventing attachment to epithelial cells, mucuscontains IgA antibodies.
● Lysozyme – enzyme digests bacterial cell wall.
● Acid pH.
● Shedding and replacement of epithelium.
● Normal flora

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Facts about GI infections?

A

17mil cases per year world
3-6 mil children die
>26 bil in developing world.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Symptoms of GI Infections

A

Diarrhea
Vomiting
fever
Loss of appetite
Headache
Blood/mucus in stool

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Common causes of GI infection

A

Viral - norovirus/rotavirus

Bacterial - e.coli, salmonella, c.diff, helicobacters

Parasitic - giardiasis, cryptosporidiosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Gastroenteritis meaning

A

a syndrome characterised by gastrointestinal symptoms including nausea, vomiting, diarrhea and abdominal discomfort

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Dysentery meaning

A

an inflammatory disorder of the gastrointestinal tract often associated with blood and pus in the faeces and accompanied by symptoms of pain, fever, abdominal cramps; usually resulting from disease of the large intestine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Enterocolitis meaning

A

inflammation involving the mucosa of both the small and large intestine.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is
Escherichia coli

A

Although E. coli is part of the normal flora, some strains can cause enteritis by a variety ofmechanisms.

❖ Can cause severe stomach cramps, bloody diarrhea and vomiting.

❖ There are four main types of enteropathogenic

E. coli, which cause enteritis.
Enteropathogenic E. coli (EPEC).
Enterotoxigenic E. coli (ETEC).
Enteroinvasive E. coli (EIEC).
Verocytotoxin-producing E. coli (VTEC)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is Enterotoxigenic E. coli (ETEC)

A

Most important bacterial cause of diarrhea in children in developing countries.

  • Most common cause of travellers’ diarrhea.
  • It produces enterotoxins(heat stable-ST and heat labile-LT) which are similar to cholera toxins.
  • Water contaminated by human or animal sewage may be important in spread
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is Enteroinvasive E. coli (EIEC)

A

Important cause of diarrhea in areas of poor hygiene.* Invasion of the intestinal mucosa, resulting in bloody diarrhoea.* Infections usually foodborne; no evidence of animal or environmental reservoir

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is Verotoxin-producing E. coli (VTEC)

A

Serotype 0157 most important EHEC in human infections.

  • Causes two distinct conditions: haemorrhagic colitis due to the local action of the toxin on the gut or haemolytic uraemic syndrome in which the toxin causes haemolysis secondary to systemic microvascular angiopathy leading to renal failure.
  • Food and unpasteurised milk important in spread
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is Enteropathogenic E. coli (EPEC)

A

EPEC strains belong to particular O serotypes.
* Cause direct damage to the intestinal wall and cause a diarrhoeal disease among infants, with bloody, mucous stools.
* Importance in adults not known

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Pathogenesis of E. Coli

A
  1. The E coli strains associated with haemorrhagic colitis (i.e. VTEC), produce relatively large amounts of the bacteriophage-mediated Shiga-like toxin.
  2. Shiga toxin (Stxs) are a family of bacterial exotoxins responsible for bloody diarrheal disease that can progress to life-threatening systemic diseases, such as renal failure syndrome (HUS).
  3. The toxins activate innate immune cells, such as neutrophils or monocytes that act as “carrier” cells to deliver Stxs in the bloodstream and kidney.
  4. Toxins bind to GB3 receptors, globotriaosylceramide, which are present in renal tissue more than any other tissue
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is salmonella?

A

Salmonellae are the most common cause of food-associated diarrhea in many developed countries.

❖ All salmonellae except for S. typhi and S. paratyphi are found in animals as well as humans.

❖ Transmitted via contaminated food, especially poultry and dairy products.

❖ Can be transmitted from person to person.

❖ Salmonellosis ranges clinically from the common Salmonella gastroenteritis (diarrhea ,abdominal cramps & fever) to enteric fevers (including typhoid fever)

17
Q

Pathogenesis of Enteric Fever - Typhoid

A
  1. Ingestion
  2. Pass through gastric acidity
  3. Small intestine (multiply)
  4. Mucosal penetration (minimal epithelial damage)
  5. Intestinal lymphatics
  6. Thoracic duct
  7. Bloodstream
  8. Spleen, liver, reticulo endothelial system
  9. Intracellular multiplication
  10. Reenter blood
  11. Re enter intestine through bile.
18
Q

Complications of enteric fever - typhoid

A

Intestinal perforation and/or bleeding
● Hepatic or splenic abscesses
● Meningoencephalitis
● Nephritis, Arthritis or Osteomyelitis

19
Q

Campylobacter

What is it?

A

Campylobacter species cause acute gastroenteritis with diarrhea, abdominal pain,fever, nausea, and vomiting.

❖ Poultry is the source of the majority of contamination.

❖ Pathogenesis and symptoms similar to salmonella.

❖ Incubation time and duration longer.

❖ The role of toxins in pathogenesis is unclear.

20
Q

How is campylobacter classified?

A

The delay in recognising the pathogenesis of these organisms is due to theircultural requirements.

❖ Campylobacter pylori, now classified as Helicobacter pylori is an importantcause of gastritis and gastric ulcers.

❖ Campylobacter jejuni is also one of the most common species

21
Q

What is Helicobacter pylori

A

The main cause of chronic gastritis. The infection usually remains in the stomach for decades. In a few patients, this may lead to ulcer and gastric carcinoma.

● H. pylori prevalence ranges between 85% and 95% in developing countries and between 30 and 50% in developed countries.

● How H. pylori is acquired and its route of transmission are unknown since humans are the only known reservoir of infection

22
Q

Pathogenesis of Helicobacter

A

H. pylori pathogenesis is mediated by four steps:

● Survival in the acidic stomach

● Flagella-mediated motility colonisation of the gastric mucosa.

● Attachment to host cells by adhesins/receptors interaction.

● Tissue damage by toxin release including Cytotoxin-associated gene A (CagA), Vacuolating cytotoxin A (VacA).

23
Q

What is Food-associated infection vs food poisoning:

A

Food-associated infection – food acts as a vehicle for the pathogen and provide conditions for multiplication.

● Food poisoning – consumption of food containing toxins.

● Toxins, may be chemical (e.g. heavy metals) or bacterial in origin.

● Bacteria multiply and produce toxins within contaminated food.

● Bacteria destroyed during cooking but toxins unaffected.

24
Q

Food Poisoning

Common causes

A

● Enterotoxin of Staphylococcus aureus

● The heat-resistant spores of Bacillus cereus

● Spores of Clostridium botulinum cause infant botulism: rare but severe/Honey

● Listeria monocytogene

25
Q

Diagnosis of bacterial causes of infective gastroenteritis

A

Stool culture on selective media.

● Serologic identification of a specific isolates like Widal test (Typhoid fever).

● Demonstration of toxin production, and Identification of genes encoding these virulence factors.

● Blood culture / Bile culture.

26
Q

Treatment of bacterial causes of infective gastroenteritis

A

Maintenance of hydration

● Ciprofloxacin may be considered for severe diarrhoea, caused by, Salmonella or Campylobacter spp(fever)

● Antibiotics should not be used for VTEC, antibiotic exposure causes a ‘stress’ response in VTEC, whichresults in increased toxin production.

● Antidiarrheal drugs should be avoided, as they can allow pathogens to proliferate

27
Q

Prevention

A

Vaccines - Typhoral, typhim vi

Sanitation

Antibiotic

Rehydration

28
Q

What are the viral causes?

Describe

A

Up to 1 million infants worldwide die of viral gastroenteritis every year.

● No specific treatment, except fluid replacement.

● Not distinguishable clinically from other types of gastroenteritis.

● Laboratory diagnosis is by electron microscopy or by the direct detection of virus particles by immunoassays, e.g. ELISA or PCR, depending on the virus being detected.

29
Q

What is Rotaviruses?

A

The infecting dose is small and spread is generally person to person.

❖ Replicating Rota virus cause diarrhea by damaging the transport mechanism in the gut.

❖ Rotaviruses induce a clinical illness characterised by vomiting, diarrhea, abdominal discomfort, fever, and dehydration.

❖ It occurs primarily in infants and young children and may lead to hospitalisation for rehydration therapy.

❖ Rotavirus infections are most common in the winter, with epidemics occurring occasionally in nurseries.

30
Q

Pathogenesis of Rotaviruses

A
  1. Rotaviruses damage enterocytes and disrupt enterocyte transport mechanisms, resulting in loss of water and electrolytes and diarrhoea
  2. Infection of the enterocyte leads to virus entry, uncoating of the virus, transcription of nucleic acid, translation of viral proteins
  3. The NSP4 protein of rotavirus acts in a toxin-like manner to promote calcium ion influx into enterocytes
  4. The loss of fluids and electrolytes can lead to severe dehydration and even death
  5. Attachment of rotavirus is mediated mainly by viral protein 4 (VP4)
  6. Neutralising antibodies directed against VP4 or VP7 (or both) can prevent viral binding and penetration
31
Q

Other viruses causing diarrhoea

A

Other viruses causing diarrhea include
Aliciviruses,
Astroviruses,
Adenoviruses (types 40 and 41),
Parvoviruses
Coronaviruses

32
Q

What is Protozoal causes of infective gastroenteritis?

A

Giardiasis

33
Q

What is Giardiasis

A

Giardia lamblia (Giardia intestinalisis) is the first intestinal microorganism to be viewed under the microscope

● It is a cyst-producing parasite. Giardia cysts can survive for extended periods of time in the environment and chlorination of water cannot inactivate them.

● Giardia infection may be asymptomatic or it may cause chronic diarrhoea

● The main consequence of Giardia colonisation is nutrients malabsorption.

● They can be treated with drugs including mepacrine hydrochloride, metronidazole

● Identification of Giardia in a specimen does not necessarily mean that this organism is responsible for the patient’s symptoms. Giardia should be treated and eliminated when found, but other pathogens should be sought as well

34
Q

Pathogenesis of Giardiasis

A

Infection occurs when a person swallows Giardia cysts

● each cyst releases two trophozoites through a process called excystation

● Giardia trophozoites multiply by splitting in two

● Cause enterocytes damage and loss of brush border of the epithelial cells of the intestine

35
Q

Diagnosis and Treatment

A

Identification of cysts or trophozoites in the feces
* Direct Immunofluorescence Assay (DFA)
* Duodenal aspirates or duodenal mucosal biopsies
* Treatment of choice for treating Giardia infections is quinacrine hydrochloride
* This drug frequently causes dizziness, headache, and vomiting
* Metronidazole and furazolidone also may be used