Microbiology of the Gastrointestinal Tract

Microbiology department FK UHT

Composition and Distribution of the Intestinal Microflora

The intestinal microflora is a complex

ecosystem containing over 400 bacterial species. facultative anaerobes. The flora is sparse in the stomach and upper intestine, but luxuriant in the lower bowel. Bacteria occur both in the lumen and attached to the mucosa, but do not normally penetrate the bowel wall . The flora also plays a role in fiber digestion and synthesizes certain vitamins.

 The intestinal microflora prevent infection by

interfering with pathogens. The flora includes low populations of potentially pathogenic organisms such as Clostridium difficile. Antibiotics that disturb the balance of the normal flora can support both infection by exogenous pathogens and overgrowth by endogenous pathogens. If the bowel wall is break, enteric bacteria can escape into the peritoneum and cause peritonitis and abscesses.

Protective Activities of the Flora

the intestinal microflora maintaining roughly

constant numbers and types of bacteria in each area of the bowel. The stability of normal flora both discourages infection by exogenous pathogens and prevents overgrowth of potentially pathogenic members.

 Antibiotics that kill off part of the intestinal flora

can disturb its balance and may open the door to infection or pathologic overgrowth. Normal individuals are quite resistant to Salmonella, and a large oral inoculum is required to initiate infection. If the intestinal flora is suppressed by antibiotics, however, the individual becomes much more susceptible and can be infected by a relatively small inoculum.

Bacterial Diarrheas Enterotoxin-Mediated Diarrheal Diseases

by Vibrio cholerae and ETEc 1. there is intestinal fluid loss that is related to the

action of an enterotoxin on the small bowel epithelial cells. 2. the organism itself does not invade the mucosal surface; it colonizes the upper small bowel, adhering to the epithelial cells and elaborating the enterotoxin. The mucosal architecture remains intact with no evidence of cellular destruction. Bacteremia does not occur. 3. the fecal effluent is watery and often voluminous, so that the diarrhea can result in clinical dehydration. The fluid originates in the upper small bowel, where the enterotoxin is most active.

Gastrointestinal Disease Caused by Invasive Bacteria

invasive bacteria exert their main impact on the

host by causing gross destruction of the epithelial architecture; histologic findings include mucosal ulceration and an inflammatory reaction in the lamina propria. The principal pathogens in this group are Salmonella, Shigella, Campylobacter, invasive E coli, and Yersinia. The enteric viruses also invade intestinal epithelial cells, but the extent of mucosal destruction is considerably less than that caused by invasive bacterial pathogens.

 Salmonella species are a common cause of food

poisoning. The main site of attack is the lower ileum, where the salmonellae cause mucosal ulceration. They rapidly make their way through the epithelial surface into the lamina propria and enter the lymphatics and bloodstream.

Two virulence factors are associated with intestinal infection: one responsible for mucosal invasion, and the other causing secretion of fluid and electrolytes into the bowel.

Shigella
an invasive diarrheal disease of the lower bowel in

which the stool contains an inflammatory exudate composed of PMN cells. invade the epithelium of the colon and cause superficial ulceration. Two virulence factors : initial penetration of the mucosal surface by destroying the brush border; the bacteria are subsequently engulfed by invagination of the plasma membrane. virulence factor allows the organism to multiply within the mucosal tissue. Mucosal ulceration results, accompanied by an intense inflammatory response in the lamina propria. bacteremia are uncommon.

Viral Diarrheas
The rotaviruses are a very important cause of

infantile diarrhea. Adults may be infected virus, but clinical disease appears almost exclusively in children younger than 2 years. Calicivirus, can produce gastroenteritis in all age groups. The initial lesion forms in the proximal small bowel. The mucosal architecture is damaged, with shortening of the villi and hyperplasia of the crypts. An inflammatory exudate then appears in the lamina propria.

Parasitic Diarrheas

Several species of protozoa and helminths can

cause diarrheal disease, although exposure to enteric parasites is more common in tropical and developing countries. Some of the more common causes of parasitic diarrhea are Entamoeba histolytica, Giardia lamblia, Strongyloides stercoralis, and the intestinal flukes.