Salmonellesis Shigellosi E.

Coli Staph Botulism Intestina

(non- s Entero Entero Entero Entero Entero intox-n l
typhoidal) patogeni toxigeni hemorrhag aggregati invasive Yersinio
c c ic ve sis
Etiology Gram negative, Gram small, small, small, gram small, small, Staphyl Clostridiu Yersinia
motile negative, gram gram negative gram gram ococcus m enterocol
S.entiritidis non- negative negative rods, , negative negative aureus botulinu itica
S.Typhymurium motile, rods, , rods, , motile, rods, , rods, , Gram m Gram
S. panama, S. non- motile, motile, Escherichia motile, motile, positive, Anaerobi negative
anatum, S. capsulated Escherich Escherich coli Escherichia Escherichi spheric c gram bacillu,s
derby Sh.Dysentr ia coli ia coli coli, a coli al cocci, positive, pleomor
Toxigenity Endotoxin: iae. Shiga toxin heterogen non- Serotype phic,
- fever, Sh.Flexneri Endotoxi heat- 1 or 2, ous O motile, s A to G family
- microcirculatio Sh. bodyii n stable 0157:H7 or collection serotypes: non- Enteroba
n failure, septic Sh.Sonnei (STa) other types, of strains O124, spore cteriacea
shock. and (mostly O O143, forming, Potent e,
Enterotoxin Endotoxin heat- and H), O164 coagula neuroto
(cholera like Shiga labile 0104:H4 closely se- xin
toxin): act toxin enteroto related to negative Pore-
adenylatcyclas xins adhesins Shigella staphyl forming
e and Shiga Verocytot ococci toxins,
toxins, oxin, (S. YaxA
entero- enterotox epiderm and
aggregati in, idis, S. YaxB
ve heat shigalike saproph
stable toxin, yticus, S.
enterotox haemoly
in ticus)

Enterot
oxin
(A,B,C1,
C2,D,E)

Epidemiology Anthropo- Age = 1-5 Worldwi Endemic Highly Worldwide Developed Develop Human Worldwi
zoonotic years de, in Children < 5 , in infants, and ing botulism de,
Mechanism of disease, 40% - children, developi year old, fecal-oral developin countrie = Fecal-
transmission Fecal-orally, children, anthropo ng route g s, worldwid oral,
contaminated 20% - zoonotic, countries Fecal -oral countries, usually e, ingestion
 food and water, adults with fecal- in all age, person-to- ingestion in food- of
Close contact household oral, poor travelers, person of infants. born = contamin
contact hygiene, contamina Worldw home- ated food
ted foods ide, canned or water,
Anthropon or water person food through
os disease to (mushro direct
Fecal- person om, inoculati
orally, contact, vegetable on
contamina by , meat), through
ted food, aerogen fish blood
Close ic way Contamin transfusi
contact and ated with on
aliment spores
S.sonnei - ary way, preserve
usually by by d food,
alimentary contami not
way, nated cooked
S.flexneri food, food
and under
S.boydii - heat,
by toxin
alimentary producti
way on in
S.dysenteri canned
a - by food;
person to Ingestion
person /
contact. inhalatio
n;
Iatrogeni
c=
cosmetic
and
therapeu
tic
Source of Carrier Infected infected contamin undercooke Contamina Human Food Food- Contamin
transmission patients, humans, person, ated food d ground ted foods and (sliced born, ated
Wild and Carriers contamin or water beef, water, and water, animal meat, wound, Foods or
domestic Animals, ated with unpasteuriz feces, puddlin intestinal water,
animals, Birds food, human ed milk, salads, g, (ingestio dairy
(raw eggs) outbreak and fruit juice, radish sandwic n), soil products,
 s in animal carriers, proper hes), and blood,
institutio feces humans, cooking, water marine wild and
n, predispo cattle, goats (milk, environm domestic
rabbits, ses, pigs, cheese), ents animals
dogs, sheep, human Serotype (pig, dog,
cats, goats, with A, B, E, F cat, cow,
horses cattle, staphyl = in sheep,
dogs ococcal humans, goats,
infectio G = in rodents,
n, few pts in fox,
Switzerla birds);
nd, C, D = Person-
in to-person
animals is rare
Season Any season but Summer- Summer- Wet Summer Cold-dry Summer Summer Summer Winter
more incidents autumn autumn season, season
in summer and summer
autumn
Pathogenesis Endotoxin: 2 Endotoxi diarrhea Verotoxin Causes Closely Adhere Ingested, Ingestion
fever, mechanis n in small by heat- like Shiga chronic related to to inhalated of
microcirculatio m: intestine, liable toxin and diarrhea Shigella in damage or bacteria-
n failure, septic colonizatio plasmid- (LT-1) cytotoxic to and pathogeni d skin, produced containin
shock. n, invasion. mediated exterotox intestinal growth c mucosa, in the g
Enterotoxin A/E ins heat- villi and retardatio properties, tissues intestine food/wat
(cholera like histopath stable colon n in infants through and or er, in
toxin): act-n ology (Sta) epithelial in transcytos evade wound, small
adenylatcyclas with enterotox cells developing is, it into enters intestine
e, increase c- disruptio in, and countries induces host, the it
AMF, n of colonizati apoptosis, Coloniz vascular colonize
normal on invasion e in the system underlyi
microvili factors and host and ng
s (CFAs), destructio and transport lymphoid
structure adheres n of liberate ed to tissues
resulting to colonic enterot neuromu (Peyer
in epitheliu epithelial oxins scular patches),
malabsor m of cells and junctions, toxins
ption and small Enterotoxi stimulat postgangl form
diarrhea intestine ns directly e ionic pores
affected inflamm parasym and
intestinal ation pathetic cause
epithelium nerve osmotic
 ®stimulat endings lysis,
e vagus and bacterial
n.®trans peripher dissemin
mits to al ation via
vomiting ganglia; mesenter
center in neurotox ic lymph
medulla, ins nodes
and activatio and
disturbs n mesenter
activity in through ic
large binding, lymphad
intestine internaliz enitis
which ation in and
disturbs endocytic systemic
reabsorpti vesicles, infection
on®diarr transloca
hea tion to
cytosol
and
proteolys
is
causing
blockage
of release
of
acetylcho
line
Incubation Period 2-5 days, 4-7 days 12-72 hrs 1-5 days 4-8 days 8 - 72 hrs < 72 hrs Hrs- Food 4-6 days
(IP) 3d 5d 1day (a borne - (range 1-
few 18-36 hrs 14 days)
days) (ranging
hr-days)
Wound –
10 days
Clinical picture Gastroenteritis Intoxicatio Infantile Traveler’ Bloody Persistent Watery Nausea, Food- Enterocol
Nausea, n diarrhea s watery diarrhea, diarrhea diarrhea vomitin borne = itis, acute
vomiting, syndrome may lead diarrhea hemorrhagi with and g, diplopia, diarrhea,
watery green + colitis to c colitis, mucus and dysentery epigastr blurred terminal
diarrhea, no syndrome, dehydrati hemolytic vomiting (large ic pain, vision, ileitis,
pain, no mucus, Sigmoid on, uremic bowel diarrhe ptosis, mesenter
blood, colitis, electrolyt syndrome diarrhea), a, dry dysarthri ic
Enterocolitis- invasive e nausea, mouth, a, lymphad
abdominal diarrhea imbalanc vomiting, decreas dysphoni enitis,
pain, with blood, e, epigastric ed a, pseudo-
Green stool and pus, vomiting, and axillary dysphagi appendic
mucus and mucus, Watery abdominal sweat, a, itis,
blood RLQ pain, diarrhea pain, decreas symmetri septicemi
tenesmus, ed urine c a,
fever output, weaknes reactive
(40˚C), s from arthritis;
head, low
neck, grade
arms, fever,
thorax, abdomin
legs, al pain,
dizziness, vomiting.
blurred Extraint
vision, estinal
dry symptom
mouth, s=
nausea, myocardi
vomiting, tis,
paralytic reactive
ileus, arthritis,
constipat glomerul
ion, onephriti
urinary s,
retention erythema
Wound nodusum
botulism ,
= fever,
skin
infection
Intestina
l=
mostly in
infants;
paralysis,
respirato
ry failure,
Complication Dehydration Rectal Dehydrat Dehydrat Hemolytic Bloody Dehydrati Dehydr Respirato Skin rash,
(vascular prolapse, ion ion and uremic diarrhea, on, ation, ry failure, joint
collapse, intestinal malnutrit syndrome, dehydratio hemolytic orthosta death, pains,
hypovolemic bleeding, ion in hemolytic n, kidney uremic sis, dysphagi bacterem
shock, acute dysbacteri children anemia, failure syndrome, tachyca a, ia, bowel
cardiovascular osis, thrombocyt (kidney rdia, dysphoni perforati
failure, acute Pneumoni openia, failure) hypoten a, on,
renal failure) a, renal injury sion, peritoniti
Septic shock stomatitis, (kidney toxic s,
(purulent anemia, failure) shock
arthritis, hemolytic
endocarditis, uremic
meningitis etc.) syndrome,
(kidney
failure)
Diagnosis CBC Stool Smears, Tissue Detection of Stacked- Stool Clinical Physical Stool
Stool culture culture cultures culture Shiga toxin, brick culture sympto exam = culture,
microscopy and on blood test, stool culture pattern and ms of symmetri Serologic
microscop agar and ELISA, on (Hep-2 microscop enteritis c tests,
y, CBC selective passive MacConkey cell) under y, , stool descendi agglutina
(ESR, differenti agglutina agar, microscop serological culture, ng tion test,
leukocytos al media tion tests, Enzyme y, stool test, paralysis, ELISA,
is, (MacCon serologic Immunoass culture, Sereny afebrile, immunob
neutrophil key al test, ays (EIAs), detection test mentally lotting
s), agar), demonstr cytotoxic of positive intact. tests
serological biochemi ation of effects on enterotoxi animal Demonst
test, cal test, enterotox Vero cells, n, Rabbit, ration of
serologic in LT and monovalent ELISA toxin in
tests ST sera serum,
O157:H7 vomits,
detection gastric
fluid,
stool
Wound
cultures
Treatment Gastroenteritis Mild case: Self- Rehydrat Rehydration Rehydratio Rehydrati Self- Hospitali Self-
– self limited ORS, limited, ion, (ringer n (ringer on, limited, zation, in limited,
Supportive, Severe oral antibiotic lactate), lactate) antibacteri gastric severe oral
oral case: rehydrati therapy antiemetic al therapy lavage, cases, rehydrati
rehydration antibiotics on, (ciproflo (ondansetro (ciprofloxa rehydra intubatio on with
solution (ciprofloxa xacin, n), cin, tion and n. electrolyt
(ORS)/iv cin, rifamixin rifamixin) electrol Laxatives e
(lactate ringer) azithromy ) yte and replacem
cin, replace enemas ent
Enterocolilitis – ceftriaxone ment in (lactate
Antibiotics ), anti- (lactate patients ringer),
(ciprofloxacin, diarrheal ringer), w/o In severe
azithromycin, drugs ileus. cases,
ceftriaxone) (diphenox Equine antibiotic
Rehydratation ylate), antitoxin s,
ORS Gastric in food-
Gastric lavage, lavage, borne
anti-emetic anti- illness.
(ondansetron) emetic In infant
probiotics (ondansetr botulism
on) = human
probiotics botulism
immune
globulin