BIOLOGY 113 - MICROBIOLOGY

Lecture 35: Microbial Diseases of the Digestive System - Infections of the mouth, bacterial
gastroenteritis

Most infectious diseases of the gastrointestinal tract are acquired through ingestion of contaminated
food or water that contains pathogenic microorganisms or their toxins
- The digestive system (Tortora et al., Figure 25.1) may be divided into two groups of organs
= The gastrointestinal (GI) tract (which is, in a topological sense, an external surface!) consists
of the mouth, esophagus, stomach, small intestine and large intestine.
= Various accessory structures, including salivary glands, liver, gallbladder and pancreas, lie
outside of the GI tract and produce secretions that are conveyed into the GI tract
- The function of the GI tract is to provide conditions for digestion of nutrients and their transfer
to the cardiovascular and lymphoid systems for use by cells
= The combined action of enzymes produced in the GI tract and accessory structures serves to
catalyze hydrolysis of polymers (polysaccharides, lipids, proteins) to their soluble monomers
(simple carbohydrates, fatty acids, amino acids)
= The small intestine serves the process of absorption of these monomers into the bloodstream
= The processes of digestion and absorption require that large amounts of water and
electrolytes (salts) be secreted into the GI tract
· The large intestine serves the process of resorption of the water and electrolytes secreted
during digestion
· Dehydration and hypovolemia (low blood volume) resulting from inadequate resorption
are the leading pathogenic effects of bacterial and viral gastroenteritis
- The gastrointestinal tract contains an abundant bacterial flora
= Various streptococci, including Streptococcus salivarius, inhabit the mouth, along with
numerous spirochaetes and some strict anaerobes
= The stomach and small intestine have relatively few bacteria, as the conditions that favor
digestion (low pH, hydrolytic enzymes) do not favor growth of most microorganisms
= The large intestine possesses an enormous native flora
· Most of these are anaerobes, including species of Bacteroides, and are not readily isolated
in the laboratory
· The most common facultative anaerobe is Escherichia coli

Dental caries (tooth decay) involve breakdown of enamal and dentin from teeth (Tortora et al.,
Figure 25.2)
- Eventually, decay allws for bacterial invasion and necrosis of the pulp, and abcess of the bone
surrounding the tooth (Tortora et al. Figure 25.4)
- Interestingly (and just like everybody always told you), development of dental caries is closely
associated with the presence of sucrose in the diet
- Streptococcus mutans may be the most important bacterial species in development of dental
caries
= When provided with sucrose, S. mutans is able to produce dextran, a glucose polymer
(Tortora et al., Figure 25.3); plaque consists of accumulated dextran and bacterial cells
= Dextran aids in attachment of bacteria to tooth surfaces, but also prevents dilution of acids
produced during bacterial metabolism; these concentrated acids are what cause dissolution of
enamel
- Periodontal disease refers to inflammation and degeneration of gum tissue(Tortora et al. Figure
25.5); some periodontal disease may result from invasion of the gums by bacteria associated
with plaque, hence the emphasis on removal of plaque that has accumulated in the gingival
crevice
The term gastroenteritis refers to diseases causing inflammation of the gastrointestinal tract
- Although gastroenteritis in healthy adults is usually self-limiting, it remains a major cause of
infant mortality in developing countries
= This is due to interference with absorption and, especially, with resorption, leading to rapid
dehydration
= The World Health Organization's promotion of oral rehydration therapy is intended to
address the major health problem associated with gastroenteritis
- As an infectious disease, gastroenteritis may be due to either infection or intoxication
= Infection results from multiplication of a pathogen in the GI tract
= Intoxication is due to ingestion of a preformed bacterial toxin that affects GI tract function
= Infection and intoxication can be distinguished by the rapid onset of intoxication versus the
incubation time required for an infection to develop

Staphylococcal food poisoning is a very common intoxication-type gastroenteritis (Tortora et al.,

Figure 25.6)
- The symptoms are due to an enterotoxin produced by Staphylococcus aureus
- S. aureus exhibits characteristics that sometimes favor its growth in foods
= It is a common member of the human native microbiota, so food is readily contaminated with
S. aureus by handling
= S. aureus is tolerant of high osmotic pressures, allowing it to grow in foods (cured hams,
custards) where it has few competitors
- Since it is an intoxication, staphylococcal food poisoning is characterized by rapid onset of
symptoms

Shigellosis, or bacillary dysentary, is a relatively severe form of gastroenteritis caused by bacteria

belonging to the genus Shigella
- Invasion of the large intestine by Shigella cells can cause extensive tissue destruction and
profound interference with resorption, leading to severe diarrhea and dehydration
- Shigella produces Shiga toxin, which is also produced by Escherichia coli O157
- Shigella invades intestinal epethelia and can spread directly between cells (Tortora et al. Figure
25.7)

Salmonellosis is the most common form of bacterial infection-type gastroenteritis

- Taxonomy of the genus Salmonella is complex, based on reactions of an isolate with antisera
- Salmonella gastroenteritis is caused by multiplication of the bacteria in the intestinal mucosa
- Occasionally, the bacteria may invade the bloodstream, leading to potentially fatal septicemia
= Fortunately this is a strain characteristic, and the invasive strains are relatively rare
= The most virulent are Salmonella typhi, the agent of typhoid fever
- Salmonella are frequent contaminants of meat products, especially poultry
- Salmonellosis is usually mild, and is probably underreported
- Typhoid fever results from Salmonella crossing the intestinal epithelium and entering the
bloodstream (Tortora et al. Figure 25.8)

Cholera, perhaps the most infamous form of bacterial gastroenteritis, is caused by the Gram-
negative, rod-shaped Vibrio cholerae (Tortora et al., Figure 25.11)
- Cholera is endemic in western Asia, and continues to cause epidemics where war or natural
disasters disrupt normal water treatment and other precautions to prevent fecal-oral transmission
-
- V. cholerae grows in the small intestine and secretes an enterotoxin, choleragen, that causes
secretion of water and electrolytes into the GI tract
= This massive fluid loss (up to 20 liters per day) can lead to shock, and often death
= Constant fluid replacement through oral rehydration therapy may be necessary until the
bacterial infection is cleared
- Like other bacterial species causing gastroenteritis, strains of V. cholerae vary in virulence and
pathogenicity
- Another Vibrio species, V. parahaemolyticus, is a common cause of bacterial gastroenteritis in
eastern Asia

Although Escherichia coli is best known as a commensal in the lower intestine, certain strains are
capable of causing gastroenteritis
- It is estimated that over half the cases of "traveler's diarrhea" are due to pathogenic E. coli
= Most of these are enterotoxigenic strains, in which pathogenesis is due to a enterotoxin
produced by the bacteria
= Some E. coli strains are enteroinvasive and can invade the intestinal epithelium
= Of greatest current concern in the U.S. are enterohemorrhagic E. coli (EHEC), including the
well-covered “O157” strains
· EHEC have been associated with hemolytic uremic syndrome (HUS), leading to kidney
failure
· Concern with EHEC has heightened awareness of safe food handling practices
- Diagnosis of E. coli gastroenteritis is hindered by the difficulty in distinguishing between
pathogenic and nonpathogenic strains

A few forms of bacterial gastroenteritis have received increased attention because their incidence is
probably greater than had been realized previously
- In most cases of acute gastroenteritis, with limited diarrhea and abdominal cramping, the
pathogen is never identified (and, in fact, the disease is never treated by a physician)
- Campylobacter, found as part of the GI flora in a number of animals, is now known to be the
second-most important bacterial cause of diarrhea in the United States (behind Salmonella)
- Yersinia enterocolitica and Y. pseudotuberculosis are likewise transmitted from animal hosts
- Clostridium perfringens and Bacillus cereus are common soil organisms that have been
implicated in cases of gastroenteritis acquired from contaminated foods

Helicobacter pylori is now recognized as responsible for peptic ulcer disease (Tortora et al. Figure
25.12)
- H. pylori is able to survive in the acidic environment of the stomach due to strong urease activity
- Peptic ulcer disease results from an inflammatory response, probably initiated by leucocytes
responding to H. pylori colonization
- Peptic ulcer disease can be effectively treated with antibiotics