INFECTIOUS DISEASES : GASTROINTESTINAL INFECTIONS AND FOOD POISONING

DIARRHEA

֍ Alteration in a normal bowel movement characterized by an increase in the water content, volume, or
frequency of stools.
 Epidemiologic Investigations use the definition of more than three bowel movements per day
֍ Acute Diarrheal Illness
 Most common problem evaluated by clinicians
 Most cases are caused by viruses
 Common cause in children : Rotavirus
 Common cause in adults : Norovirus  Cruise-ship diarrhea
 Traveler’s Diarrhea – caused by bacteria
 Montezuma’s Revenge  Malta Dog
 Dehli Belly  Canary Disease
 Greek Gallop  Basra Belly
 Rome Runs  Maladie de la Mer Rouge
 Aztec Two-Step  Poonah Pooh
 Back Door Sprint  Hongkong Dog
 Turkey Trots  Ho Chi Minh
 Turista  Rangoon Runs
 Casablanca Crud  Tokyo Trot
 Singapore shakes  San Franciscitis
 Gyppy Tummy  Trotsky’
 Aden Gut
֍ Food Spoilage
 A food is considered spoiled if it is contaminated with pathogenic microorganisms or various
poisonous agents such aas pesticides and heavy metals
 Causes of food spoilage includes microorganisms, enzymes, chemical reactions, Vermin, and
physical changes.
 Vacuum-packaged smoked bacon / sausages
 Lactic acid bacteria (LAB) mainly Leuconostoc and Lactobacillus dominated the
microbial population after seven days of storage.
 Lactobacillus spp. contain microaerophilic, catalase-negative, gram-positive
rods capable of producing lactic acid from glucose fermentation
 Leuconostoc mesenteroides and Leuconostoc carnosum were the most prevalent
species since day 15, while Lactobacillus sakei and Lactobacillus curvatus were only
found on day 45, suggesting that they could be responsible for the spoilage of
bacon.
 L. sake is the main cause of a highly offensive and commercially important specific
spoilage phenomenon and it seems to be the most important spoilage strain in
vacuum-packaged sausages
֍ Evaluation
 Dietary History
 Travel History
 Sesonality
 Daycare attendance
 Living conditions
 Duration of symptoms
 Acute : < 14 days
 Persistent : > 14 days but < 30 days
 Chronic : > 30 days
 Symptoms of Inflammation
 Fever, bloody stools, tenesmus  more invasive disease
 History of Previous GI symptoms
 May suggest Inflammatory Bowel Disease or Irritable Bowel Syndrome
 Underlying Illnesses
 Medications
 Recent history of antimicrobial use may suggest infection with Clostridioides difficile
֍ Anatomic Considerations
 Normal Gastric pH is 4 and kills more than 99.9% coliforms within 30 minutes
 Resistant organisms : cyst phase of some parasites, some bacterial spores
 Normally, the upper small intestine contains only sparse microbiota (bacteria, primarily
streptococci; lactobacilli; and yeasts; 101-103/mL), but in the distal ileum, counts are about
106 to 107/mL, with Enterobacteriaceae and Bacteroides spp. predominantly present.
  The normal microbiota of the adult large bowel (colon) is established relatively early in life
and consists predominantly of anaerobic species, including Bacteroides, Clostridium,
Peptostreptococcus, Bifidobacterium, and Eubacterium.
 Enterobacteriaceae, enterococci, and streptococci, are outnumbered by anaerobes 1000:1.

Epidemiology

Institutional Settings

 Daycare centers, hospitals, and nursing homes

 Daycare centers
o Shigella, C. jejuni, G. duodenalis, Cryptosporidium, and rotaviruses have been reported
to cause outbreaks
 Nursing Homes
o Same organisms + E. coli O157:H7
 C. difficile is a major enteric pathogen that has been identified in outbreaks in hospitals and other
settings, including nursing homes and extended-care facilities.
o a hardy pathogen that readily survives on fomites (inanimate objects) such as floors, bed
rails, call buttons, and doorknobs and on the hands of hospital personnel caring for the
patient.
o Emerging strain with increased virulence and fluoroquinolone resistance
o most common pathogen isolated in patients with antibiotic-associated diarrhea (may also
be caused by K. oxytoca)

Foodborne and Waterborne illnesses

 Bacillus cerues and Bacillus anthracis

 Salmonella and Shigella
 Yersinia enterocolitica
 Vibrio and Aeromonas
 Norwalk Virus
 Giardia duodenalis

Immunocompromised Hosts

 Salmonella, Shigella, Campylobacter

 CMV
 Cryptosporidium, Isospora belli
 Microsporidia
 Entamoeba histolytica/dispar
 Mycobacterium spp.
 Giardia duodenalis