Infeksi Gastrointestinal

non diare
Dian Widiyanti, SSi., MSi, Ph.D
Bagian Mikrobiologi
Fakultas Kedokteran Universitas YARSI
Helicobacter pylori
History
Barry Marshal & Robyn Warren in
1982 Campylobacter pyloridis
from dyspepsia patient now
known as Helicobacter pylori
In 2005 nobel prize in
physiology or medicine

Morphology
Spiral with 1-3 turns, 0.5 5 m in length,
with 5 to 7 polar sheathed flagella
Motile with corkscrew motility
Slow growth (3-6 days) at 37
o
C
pH optimum 6-7
Microaerophilic organism
Oxidase positive, catalase positive, produce
urease
Cause acute or chronic gastritis,
predisposing factor in peptic ulcer, gastric
carcinoma, MALT lymphoma
Transmission
Risk factor
Virulence Factor Effect
Colonizing
Flagella Active movement through mucin
Urease Neutralization acid
Adhesin Anchoring to epithelium
Tissue damaging
Proteolytic enzymes Glucosulfatase degrades mucin
120-kDa cytotoxin (Gac A) Related to ulcer and severe gastritis
Vacuolating cytotoxin (Vac A) Damage of the epithelium
Urease Toxic effect on epithelial cell, disrupting tight junction
Phospholipase A Digest phospholipid in cell membrane
Alcohol dehydrogenase Gastric mucosal injury
Survival
Intracellular surveillance Prevent killing in phagocytes
Superoxide dismutase, catalase Prevent phagocytosis and killing
Coccoid forms Dormant form
Heat shock protein
Urease Sheathing antigen
Other
Lipopolysaccharide Low biological activity
Lewis X/Y blood group homology Autoimmunity
Pathogenesis
Clinical sign and symptoms
Upper abdominal pain
Nausea and vomiting
Frequent burping
Bloating
Loss appetite,
Fast satiation
Weight loss
Bleeding from stomach lining (severe case)
Stages in Helicobacter infection
H. pylori induce autoimmune
Diagnosis
Non invasive test
Urea breath test
Stool antigen
Serology (ELISA)

Endoscopic based test
Rapid urease test
Histology
Culture (Br+5% horse
blood or BHI+ 7% horse
blood) 5-10% O2, 5-
12% CO2 5-7 days at
37
o
C
Treatment
Kombinasi beberapa antibiotik + inhibtor pompa proton
Contoh amoksilin, metronidazol, omeprazol
Leptopirosis
Occupational hazard of rice harvesting (China), autumn fever (Japan)

Adolf Weil in 1886 the first modern clinical description of
leptospirosis which characterized by splenomegaly, jaundice, nephritis
Weils disease

Inada et.al in 1916
isolated leptospires,
identified the organism as the causal agent of leptospirosis
determined that rats are reservoir for transmission to human

Classification
Order: Spirochaetales
Family : Leptospiraceae

L. interrogans sensu lato (>240 serovar, 24
serogroups)
L. biflexa sensu lato (>60 serovars)

Genotypic classification 20
genomospecies
Morphology
Spiral-shaped bacterium
Size 0.1 x 6-20 m
Highly motile
Has two axial filament (endoflagella) at its ends
Obligate aerobes
Slow growth with optimal temperature 30
o
C
Has Gram-negative bacterial cell wall
Reference: Albert I. Ko, et.al., 2009, Nature Reviews Microbiology, 7:736-747
(Reference: Jurg Utzinger, et.al., 2012, Swiss Medical Weekly
142:w13727)
Reservoir
host
Cattle Dog Sheep and
Goat
Horses Pig
Leptospira
serovars
Pomona
Hardjo
Canicola Pomona
Hardjo
Bratislava
Pomona
Bratislava
Australis
Pomona
Symptoms
and
syndromes
Reproductiv
e failure
Abortion
Still-births
Fetal
mummificati
on
Weak calves
Milk drop
syndrome
Icteric
Hemorrhagic
Uremic
(Stuttgart
disease)
Abortion and
premature or
weak pups
Septicemia
Redwater
Abortion
Milk drop
syndrome
Abortion
Redwater in
foals
Moon
blindness

Abortion
Still-birth
Weak piglets
Leptospirosis in Animals
Mice (Mus musculus) and rats (Rattus norvegicus and Rattus rattus) dont show
sign but harbor leptospires in kidney
Hamsters and guinea pigs are highly susceptible and can be used as animals
models of human leptospirosis
Leptospirosis in humans
Reference: Feigin RD, Anderson DC: Human leptospirosis. CRC Crit Rev Clin
Lab Sci 1975;5: 413-67. Copyright CRC Press, Inc., Boca Raton, FL
Pathogenesis
The clinical manifestations are caused by damage to the
endothelial lining of small blood vessels by mechanisms that are
still poorly understood. Infection multisystem. Some virulence
factors hemolysin, Lig A and Lig B, LPS

Treatment
Penicillin i.v., amoxicillin, ampicillin, doxycycline, eritromicin
Jarisch-Herxheimer reaction may appear following penicillin
treatment

Prevention
Prevention and control should be targeted at :
(a) the infection source;
(b) the route of transmission between the infection
source and the human host
(c) infection or disease in the human host.
(Reference: Pappas G., P. Papadimitriou, V. Siozopoulou, L. Christou, and
N. Akriditis. 2008. Int. J. Infect. Dis. 12: 351-357
The Caribbean and Latin America, the Indian subcontinent, Southeast Asia,
Oceania, and to a lesser extent Eastern Europe, are the most significant foci
of the disease
Clinical sample for leptospirosis diagnosis

1. Blood
Blood is used for culture, collected with heparin to prevent clotting
on the first 10 days. Ten days after the onset, leptospires mostly
dissappeared from blood.
2. Serum
Serum is used for serologic test, collected two times at interval several
days. To detect rise in titres between two samples or seroconversion and
confirm the diagnosis
3. Urine
Midstream urine is collected and cultured as soon as possible (2
hours after sampling) because leptospires die quickly in urine.
4. Postmortem
Collected from many organs soon after the death and transported to
laboratorium in 4
o
C to prevent autolysis.
5. CSF

Diagnosis of leptospirosis
Detection of host response
Microscopic Agglutination Test (MAT)
one of the gold standard in diagnosis of leptospirosis. Serum of
suspected patient is reacted to culture of leptospira strain. The
agglutinated of leptospires will form clumps. MAT result is
determined positive if the proportion of free leptospires is less
than 50%.
Enzyme-Linked Immunosorbent Assay (ELISA)
using wide variety of leptospiral sonicates to recombinant
protein (i.e. LipL32, LigA, OmpL1).
IgM dipstick
detect the IgM which appeared during acute phase and often
use for initial screening.
Microcapsule Agglutination Test (MCAT)

Detection of causative agent
Culture
growth in EMJH or Korthof medium. Definitive diagnosis, but
need long incubation due to slow growth of Leptospira strains
Polymerase Chain Reaction (PCR)
has high sensitivity
Loop-mediated isothermal amplification (LAMP)
amplification of DNA under isothermal condition and the result
can be seen with naked eye. It has high sensitivity and
specificity, no need sophisticated equipment.
Latex agglutination, immunofluorescence, immunoprecipitation
lack of sensitivity and specificity
WHO References
1. The culture of sample from normally sterile organ, showed
sufficient growth
2. Clear amplified DNA in PCR from organ or body fluid
3. Four-fold increase of titers between acute and convalescent sera in
MAT