infeksi git by e.coli & salmonella spp rev 2016

8/17/2019 Infeksi GIT by E.coli & Salmonella Spp Rev 2016

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GASTROINTESTINALTRACT INFECTIONS

Ike Irmawati P.A


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Introduction

Gastroenteritis gastrointestinal

symptons : nausea, vomiting, diarrhea &

abdominal discomfort

Diarrhea

abnormal fecal discharge : frequent &/orfluid stool

Resulting from disease small intestine

↑↑ fluid & electrolyte loss


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Dysentry An inflammatory disorder of G!

Associated "ith : blood & pus in feces

#ymptoms : pain in anus, fever, abdominalcramps

Resulting from disease large intestine

$nterocolitis inflammation involving the

mucosa small & large intestine


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21/12/08

Pathogenesis


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nfections

ingested in sufficient number

$lude host defenses of upper G! & reach

the intestine

Diarrhea the most common outcome of

G! infection


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anamnesis

%atients recent food

!ravel history

'acroscopic & microscopic of the fecesblood, pus/ mucous


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Escherichia coli


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Escherichia coli

(ormal gut flora

'ay also inhabit female genital tract

%ossess virulence factors intestinal

tract or at other site )eg* +rinary tract


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Escherichia coli

#pectrum of disease:

– -acterimia

– +rinary tract infection: caused .0 case1 hemolisin)2, virulensi factor pili % +%$3 )uropathogenicE.coli

– (eonatal meningitis: E. coli 45 '($3

)meningitis/ sepsis6associated E.coli)

– Nosocomial infection

– Gastroenteritis )Diarrea by E. coli


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7 classes )virotypes of E. coli that

cause diarrheal diseases :

5*enteroto8igenic E. coli )$!$3

9*enteroinvasive E. coli )$$3

*enterohemorrhagic E. coli )$;$3


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Mechanism of virulence


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Patogenesis


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ETEC

>irulence

fimbrial adhesins e*g* 3?A , 3?A , 4..,

4@@non invasive

produce ! and/or #! enteroto8in

"atery diarrhea in infants and travelers1 noinflammation, no fever

!ransmitted by contaminated food and

"ater


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ETEC

Adult self6limited 56 day

! $Bsoto8in )subunit A & - activation ofadenilat cyclase cA'% hypersecretion of

"ater & 3l6

, as "ell as inhibiting the reabsorption(a2 hipermotilitas & diarrhea -e antigenicand similar to V. cholerae enteroto8in

#! !o8in : activation of guanylate cyclase cG'% "ater secretion

-acteria has coloniCation factor in the smallintestine epithelium gen faBtor Bolonisasi terBait

plasmid


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Patogenesis ETEC


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EPEC

non fimbrial adhesin )intimin & !ir

)translocated intimin receptor, -fp

)bundle-forming pili and

$%$3 adherence factor )$A? enableslocaliCed adherence of bacteria to

mucosal intestinal cells changes in cell

surface )loss of microvilli

does not produce ! or #!1 some reports

of shiga6liBe to8in


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EPEC

usually infants diarrhea & child in

developing country1 "atery diarrhea

self6limited/ chronic diarrhea

some inflammation, no fever1 symptoms

probably result mainly from invasion

rather than to8igenesis


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EHEC

>!$3 #!$3

adhesins not characteriCed, probably fimbriae

moderately invasive

produce shiga to8in >eroto8in

pediatric diarrhea,

nflammation & bleeding mucosa of large

intestine )hemorrhagic colitis

may be complicated by hemolytic uremiasyndrome )to8in mediated damage to Bidneys

characteriCed by: hemolytic anemia & lo" platelet

count


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EHEC

after attachment at mucosa of colonproduce to8in effects on the intestinal

epithelium diare

3aused hemorrhagic colitis and hemolyticuremic syndrome );+# veroto8in

receptors found in renal epithelium

Acute renal failure

solate E. coli E5=F:;F & E97 )epang,95, sorbitol )6

!ransmitted by ingestion of undercooBed

beef or ra" milB


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EHEC


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EIEC

nonfimbrial adhesins

possibly outer membrane protein

invasive )penetrate and multiply "ithinepithelial cells

dysentery6liBe diarrhea )mucous, blood

necrosis, ulceration & inflammation of the

large bo"el high fever, malaise, headache, abdominal

pain


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EIEC

+sually seen in young children living in

areas of poor sanitation

!est aBtosa )6, test #ereny )2,

leuBocytes in feses


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E. coli invade by endocytosis inside

epithelial cell they lyse endocytic

vakuola multiply & spread to

adjacent cells tissue destruction,

inflammation , necrosis & ulceration

blood & mucus in stools

Patogenesis EIEC


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Patogenesis EIEC


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EEC

%robably involves binding by pilli

non invasive

produce #!6liBe to8in )$A#! and a

hemolysin6liBe to8ins

persistent "atery diarrhea in young

children "ithout inflammation or fever


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EEC

!he bacteria can attach in cultur cell &

forming aggregates )stacked brick

plasmid-associated fimbriae

associated with a global aggregativeregulator gene ( Agg) responsible for

cellular adherence

#tool specimen : no bloody & no "hite

blood cell


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!EC

%roduce alpha hemolysin & cytoto8ic

necrotiCing factor 5

Diarrhea : children


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diagnose

3ulture : $ndo agar metalic colony

Inflammatory gastroenteritis


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Enteroto"igenic #ETEC$ E. coli %gram negative rod

Ingestion of comtaminated&ater or food'

ETEC has multi(le(athogenic mechanisms&hich include at least2 distinct to"ins) a heat%la*ile

to"in #+T$ and a heat sta*leto"in #,T$' +T is similar tocholera to"in' The ,T acts*- stimulation of guan-latec-clase &ith resultant c-clic.MP accumulation inmucosal cells'

Travelers !iarrhea) &ater-

self%limited diarrheavomiting cram(s nausealo&%grade fever 1% da-sduration'

Entero(athogenic #EPEC$ E. colialso called enteroadherent E. coli %gram negative rod


EPEC (roduces nodemonstra*le e"tracellularto"in' f( mediates looseattachment to microvilluscells &hich leads toincreases in Ca levels andthen rearrangements inactin Intimin (rotein neededfor intimate contact &illhuman cells and final stagesof cell destruction'

Infant diarrhea &ith fevernausea vomiting non*lood-diarrhea

Enteroaggregative #EEC$ E. coli %gram negative rod


ggregative (attern due tocertain thin (ili #.33P4fim*riae$

!evelo(ing countries(ersistant &ater- diarrhea &ith vomiting anddeh-dration in infants' Canlead to *lood- stools

Inflammatory gastroenteritis


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Escherichia coliEnteroinvasive E. coli#EIEC$- gram negativerod

Ingestion ofcontaminated foodand &ater'

Plasmid mediatedinvasion of e(ithelialcells

fever cram(ing&ater- diarrheafollo&ed *- scant*lood- stools

Escherichia coliEnterohemorrhagic E.coli #EHEC$ includesserot-(e 5167H7-gram negative rod

Ingestion ofcontaminated food#undercoo9edham*urgers$ and&ater

3eroto"in%*loc9s(rotein s-nthesis

*lood- diarrhea and insevere cases can leadto hemol-tic uremics-ndrome #H:,$

Invasive gastroenteritis


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Thera(-

#upportive therapy : oral rehydration

;+# by $;$3 : transfusion & hemodialysis

Antimicrobial therapy may shorten theduration of illness, but many of these

infection resolve "ithout such therapy

Antimicrobial therapy for non6life6

threatening infection contraindicated

develop resistance

?ood sanitation and environment


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,almonella


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'orphology:

– Rod, Gram )6, motile, facultativeanaerobic

– (o fermentation lactose & sucrose

– produce ;9#

– ?reeCing temperature resistant


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!he genus !almonella has three Binds ofmaHor antigens :

5*somatic )E

heat stabile & alcoholresistant %#

9*surface ) 4 >i antigen virulence factor

capsular polysaccharide

*flagellar ); heat6labile protein!almonella enterica serovars )e*g*,$nteritidis, !yphi peritrich flagella


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;ospes:

– ;uman !. typhi" !. paratyphi A, -, 3

– %ig !. cholera-suis

– 3o" !. dublin

– #heep !. abortus suis

nfective doses !. typhi : 57 6 5@

the Salmonella strains isolated from humans

and other warm-blooded animals.


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n humans, !almonella are the cause of

three diseases called salmonellosis:

5* enteric fever )typhoid, prolonged fever

& multisystem involvement ) blood, lympnodes, liver & spleen

caused by: #* serotype !yphi, %aratyphi

A,- or 3


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Cont'

9* Gastroenteritis & diarrhea

production infection limited to the

mucosa & sub mucosa of the

gastrointestinal tract

caused by: #* serotype !yphimurium &

#* serotype $nteritidis

acute gastroenteritis, resulting from a

foodborne infection/into8ication


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* -acterimia & e8traintestinal infections

occur by spread from G!

$tiology: ! * choleraesuis

!. dublin


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Salmonella enterica serovar T-(hi'

Also called !almonella !yphi

the causative agent of typhoid fever*

!he symptoms of typhoid fever include

nausea, vomiting, fever and death*

!. !yphi can only infect humans


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!almonella enterica serovar !yphimurium #S. T-(himurium$

the most common cause of food

poisoning

n humans !. !yphimurium does not causeas severe disease as !. !yphi,

!he disease is characteriCed by diarrhea,

abdominal cramps, vomiting and nausea,

and generally lasts up to F days*


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!almonella enterica serovar $nteritidis

!. $nteritidis causes a disease almost

identical to the very closely related !.

!yphimurium*


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!. enteritidisBakteri menempel pd

epitel ilium terminal

Bakteri berpenetrasi dlm sel &

bermigrasi ke lamina propia pd

ileocecal berkembangbiak pd

folikel limfoid hiperplasia dan

hipertrofi reticuloendothelial

PMN Infeksi terbatas

pada traktus

gastrointestinal

Respon inflamasi

pelepasan Prostaglandin

cMP meningkat

sekresi cairan

meningkat

!IR"


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,almonellosis

5 billion !almonella per gram of feces

'ortality rate I 5 0

– ;igher in infants and elderly

Recovery in a fe" days

– #ome may shed bacteria in feces for 7 months


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,almonellosis

ncubation time 59 J 7 hours

-acteria invade the intestinal mucosa and

multiply

'ay pass thru mucosa into lymphatic or

circulatory system and become systemic

?ever, abdominal pain, cramps and

diarrhea


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Patogenesis ,almonellosis


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Mucosa invasion *- ,almonella

R t Ef ! i i A d Eth # Ef # l ll i


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Routes Ef !ransmission And Ether #ources Ef #almonellosis

5*!he most common route of infection is through oralingestion*

9*nfection can occur through an open cut, sore or "ound

into the bloodstream*

*nfection can occur through splashing of contaminated

material into the eyes*


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Cont'

7*mproperly cooBed meats, especially poultry and chopped

beef/porB/turBey*

F*Recontamination of cooBed meats through contact "ith

ra" meats/fluids*

.*3ontamination of foods by salmonella contaminated handsof servers/preparers*

@*3ontact "ith, ingestion or inhalation of soil contaminated

"ith animal feces*

5*Ra" milB )especially among farm families and

contaminated pasteuriCed milB*

55*?ish meal, bone meal and meat meal1 fertiliCers and

animal feeds*


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Enterocolitis

manifestation: vomiting, stomach ache,

diarrea & fever

Enset: 76


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Enterocolitis


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+a*orator-

-acterial isolation e*g* Gaal culture, ##

agar, 'ac3onBey agar, AD%, $ndo agar

#erologi e*g* !est Kidal enteriB fever

T i


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Tera(i

$nteric fever & -acteremia antibiotic: – 4hloramfeniBol, ampisilin, trimetoprim6

sulfometho8aCol, sefalosporin

$nterocolitis: – Diarrea fluid & electrolyte replacement

– Antibiotic do not reduce the sympton & may

prolong e8cretion of salmonella in the feces

3arrier: BholisisteBtomi & antibiotiB


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(revention

?ood sanitation & clean drinBing "ater

>acination


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Salmonella typhi,Salmonella paratyphi and C Salmonellacholerasuis

ingestion of fecall-contaminated food or&ater

a*le to survive inneutro(hils

t-(hoid fever (arat-(hoidor enteric fevers;

anore"ia letharg-malaise general aches(ains dull continuousheadache usuall-confined to the frontalregions non(roductivecough nose*leed #10< of(atients$ vaguea*dominal (ain anddiscomfort consti(ation#20< of (atients havemild diarrhea$ a*dominaldistension due to gas inthe intestines *lood-feces

Salmonella enteriditis(contains 7 subgroupsand 1500 serotypes)-gram negative rod

=ecal%oral transmissionvia contaminated &aterfood#(oultr- eggs or dair-(roducts$ or directl- in-oung children

nausea vomitingdiarrhea


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! E9t Mi *i l 21/1

infeksi git by e.coli & salmonella spp rev 2016

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