Transcribed by Tina Park

12.2.14

Infectious Disease Lecture 13 Campylobacter, Helicobacter , Cholera by Dr. Hanna

(Dr. Hanna was absent so Dr. Boylan gave an introduction to his lecture on the three bacteria.)
[Dr. Boylan] Im waiting for our guest lecturer to appear. Dr. Bruce Hanna. I forgot to send a
reminder, but usually he doesnt need a reminder to come. So lets give him a few more minutes.
Hes supposed to be here again tomorrow afternoon so if he doesnt come today he will finish up
most of what he had today and tomorrow afternoon. Dr. Hanna will bring you nothing but the best
for this course. He was for many years Director of Clinical Microbiology and Immunology at
Bellevue Hospital. He sort of had Dr. Tiernos position. Dr. Tiernos position at Tisch Hospital, now
Langone Medical Center. Dr. Hanna had that same position at Bellevue for many years. And he is a
proud father of two recent graduates of NYU College of Dentistry. So maybe if you were figuring
what they are doing. When he appears today or tomorrow. He lives uptown, east seventy second
street. So maybe he got caught in traffic.
But the topics for today, Campylobacter, Helicobacter, and Cholera, Let me say a few words about
them in case he doesnt show up. So when he does talk about them he can go through them a little
more rapidly. Campylobacter jejuni, of course you dont have slides up yet, the lecture has not yet
appeared. Keep an eye out, maybe they will show up a little later. Caught in traffic I hope.

Campylobacter jejuni.
Campylobacter jejuni. Helicobacter pylori, and Vibrio cholereae. Campylobacter jejuni. What is
important to know about that is it is a gram negative, a curve rod. It is a bacterium that is ordinarily
found in farm animals. It infects your GI tract. It causes a zoonosis in humans. Meat contaminated
meat. Mostly chicken or beef. But campylobacter, one thing you have to remember about it, is an
infection called Campylobacteriosis. And it is the most common food borne infection in the United
States today. More so than Salmonella, Shigella, and even E. coli. Campylobacter jejuni. So farm
animals. Zoonosis.
And actually one of the most prevalent populations of people who get sick with this type of food
poisoning, Campylobacteriosis, are your age group. Students who are in their early twenties or go
away to college, or go into dental school, away from home for their first time. And go okay I am tired
of spending all this money, going out, eating at diners or getting pizza all the time, Im going to start
cooking for myself. So often what happens is these students they get a hot plate that they are not
supposed to have in their resident halls. They sneak that in. Im going to have a chicken dinner. So
they go out and they go buy a big chicken at a supermarket. And sometimes they are contaminated
with fecal matter from the chicken that had not been thoroughly cleaned at the market or along the
way they get to your table or you havent washed it thoroughly. And you have all this bacteria there.
And you can come down with this infection. What happened was okay I will get this whole chicken
and I will put it on the hot plate. And I will turn on the hot plate real high and wait to hear all this
crackling, sizzling, and blackening of this skin. Then I will turn him over and do the same on the
other side and then Ill eat it. But that is not good enough. It doesnt kill all the bacteria around the
chicken. So you have to thoroughly heat the meat, chicken poultry, or whatever you eat before you

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eat it in order to kill the bacteria already there. So this is why it is a more prevalent infection in the
young twenties primarily. But everybody is susceptible to it. One of those food borne infections that
come from animals. Zoonosis.
What else about Campylobacter? Oh yes. One of the qualities of this particular infection is something
known as the Guillain-Barr syndrome. Hopefully that is on your notes as well. It is a neurological
problem that people have after certain infections. Maybe days or even week later. Where they have
a nervous tick or nervous disorder. They are kind of on edge. It is a neuroglogical thing. GuillainBarr syndrome. And it comes upon this. I can think of one other. The flu which is a common
complication of particular infections. This is a bacterial infection of course. Flu being a viral
infection. But right around a certain people get this Guillain-Barr syndrome. He might mention
something about this tomorrow. He has to go through these list slides tomorrow rapidly. There are
some symptoms. Really he has a lot of slides. I know he has a lot of slides. As a clinical
microbiologist we like to tell you every single thing that is possibly known about these bacteria. I
try to condense a little bit. Try to pick out what is most important. What are the most important
diagnostic tests for these bacteria we are talking about or are there certain treatments that are
unusual but designed for just these infections. I will talk about the next one in this group of bacteria.
So curve. Got negative rod. It is also known as a microaerophil. The Campylobacter jejuni. A
microaerophil. Meaning it quickly grows well with reduced oxygen tension. We are right now
breathing in air that is 20% oxygen concentration. Most of what we are breathing nitrogen. Most
bacteria will grow in the environment we are in. We put this bacteria in a plate, test tube, or
incubator they will go well. But these bacteria, the Campylobacter are in particular microaerophils.
For a long time we didnt know about them. People were getting sick. We couldnt culture any
bacteria from feces from people with diarrhea, from gastroenteritis. Until someone said, lets
reduce oxygen tension from 20% to about 5% so we have ways to do that. We have these
incubators that can reduce oxygen tension in the same way we can reduce CO2 tension inside the
incubators. We can reduce from 5% to 20%. Within these microaerophils, the Campylobacter
flourish. They grow well. We can identify them by the colonies on certain media. He will talk about
that.

Helicobacter pylori
Another one of those, the Helicobacter pylori. Also a curve gram negative rod. It has a similar
appearance to Campylobacter. This has a very interesting history I believe. This is the one that
causes peptic ulcers. This is bacterium responsible for a majority of stomach ulcers. Even
duodenum. I remember when I was a kid. One of my brothers friends who was very brilliant
throughout elementary and high school at least. And he was always coming up with ulcers. He
pushed himself to a certain extent and was put under stress all the time. He had these ulcers, eating
away at the lining of his stomach. Now we know with his case and for others as well. Bacterial
infection and the bacteria caused peptic ulcers and duodenum ulcers as well. Helicobacter flagellum.
Curved rod with a single flagellum. The reason they know this. Well the fellow who discovered that
this was the case that this bacterium caused peptic ulcers. He was one of those scientists who was

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scoffed at. Bacteria dont cause ulcers. Stress and other environmental factors, maybe chemicals,
maybe they cause ulcers. And you die. But not bacteria.
So he was onto this belief. And he was and Australian physician., a pathologist actually. He was
trying to find a similar animal study to do these studies to prove that Helicobacter pylori caused
ulcers. He couldnt find one. Hamsters, mice, rats. They could not play host to this bacterium. So
what was the only guinea pig he could use? Himself. Humans. So his name was Marshall. He was
from Australia once again. He decided he wants to show once and for all that this bacterium was
suspecting to cause ulcers. He did it to himself once again as the guinea pig. So what he did was first
he had his stomach lining inspected with an endoscope. Someone looked at it. Everything was fine.
No ulcers. No problem with the stomach tissues at all. Subsequently he took a test tube full of these
bacteria, Helicobacter pylori. To prove what he wanted to prove. I can see him standing there with
this tube full. I dont know the concentration but quite a large number. And I was thinking what did
he say? What would his people in the lab say when he was about to do this because it was a pretty
important study. If it turned out right and it did. He would say something like this is one small step
for man and one large step for mankind like Neil Armstrong said, or something like that. All he said
was, well here goes. And he swallowed it. And what did his lab mates say? They just said youre
crazy. Youre nuts.
But anyhow, he swallowed these bacteria. And a few hours later he heard gurgling and rumbling
from his gut and feeling not too well. And after a day or two of this, maybe a couple days., he did get
this gastroenteritis. Okay lets see what this lining looks like now. So back down with this
endoscope. Inspect the lining of the stomach. And saw aha! There was destruction of the lining of
his stomach. Looked down there. Picked out some samples and sure enough when streaked these
samples on a petri plate. They found the bacteria they grew. And Helicobacter pylori was like Kochs
principles, Kochs Postulates, that is. They used the same bacteria. Isolated them. Put it back in the
environment in the stomach and then re-isolated them after he got sick. That is what I like about
him. Most Noble Prize winners these days getting awarded on work in molecular biology and
physiology, immunology and all this great stuff. He got the Noble Prize. This Marshall did about 10
or so years ago for his discovery that Helicobacter pylori for causing peptic ulcers and actually can
lead to cancer as well over a long term if you harbor these bacteria in your stomach for a long time.
And it is kind of neat. How these bacteria survive in that low pH, in the acidity of the stomach. Most
bacteria dont. Most are destroyed as they pass through the stomach.
For a matter of fact, the next bacteria I am going to talk about for a little bit. Cholera you actually
need millions of bacteria to either eat or drink for them to cause cholera in you because they are
just so sensitive to low pH. This bacteria have some neat tricks to be able to survive in the stomach.
One of them is they produce an enzyme called urease. This is the enzyme that breaks down urea. So
these bacteria that are growing there and when they fuse this enzyme, urease, it breaks apart uric
acid and forms ammonia. Ammonia is one of the products when urea is broken down. And ammonia
brings the pH up a bit. So these bacteria are in the acidic environment of the stomach but they are
surrounded by a cloud of alkaline pH due to the ammonia when they break down uric acid. That is
one of the virulence factors. Another one. They have the flagellum to help them burrow down into
stomach. Helps them to stick to tissue in stomach. Couple of virulence factors. Once again it is the

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virulence factors they it has that enable them to have this particular disease. Not just one bacterium
that doesnt cause all infections. Different bacteria that have different virulence factors that it can
happen in an environment such as this. By protecting themselves from the environment. And in this
case producing an ammonium cloud around them to help them survive. And know also there is an
unusual treatment for this particular infection. Sometimes it is 1-2 antibiotics. Plus something that
might protect your stomach. Plus proton inhibitor. So I think he will talk about that later tomorrow
that has more than just one type. Two or three. It varies. It used to be one. Pepto-Bismol used to be
one. Now Im not sure what he has down. Check for it. This is an unusual treatment for this
particular infection.

Vibrio choleae
Lets see what else. The third one I dont have much to say about that. Vibrio choleae, the Cholera
bacterium. Also a curved rod. A singular polar flagellum. It is one of the few bacteria that scared
people. You hear about cholera epidemic or cholera outbreak. Cholera plague or dysentery even or
small pox over the ages. You hear about Cholera. This bacteria has a number of unusual features in
that it has caused a number of pandemics over the past century. And it has the ability to grow in
water. Both salt water and regular water. It can grow in oceans and lakes and streams. Most
bacteria cannot grow well in both types of water. Ocean and freshwater as well but this bacteria can
and it can survive and it grows well if it finds enough nutrients in the water to grow on.
Right now in Haiti there is an outbreak of Cholera. And it was from some UN workers. They came to
Haiti to help with some of the flooding a couple years ago. But they came, these UN people, and set
up an establishment, some sort of housing for themselves on top of the hills. Then more rain came.
They didnt take care of keeping their sewage away from the other streams that flow down into the
villages below. So some of these people from other countries, UN people, healthcare workers had
cholera and they spread it this way. The rain came. Streams brought Cholera down. There were
terrible, terrible outbreaks and many deaths from it. It is really a terrible infection. I read about
some books recently about people who die from cholera. It is agonizing terrible way to go because
they become completely dehydrated. Those can be very serious. GI disturbances. Diarrhea.
Gastroenteritis infections. They can be very serious when you lose a lot of water and electrolytes
that come from tissues that are being broken apart. Releasing electrolytes and salts. These
particular toxins bacteria is producing is called choleragin. And it acts the same way that the E. Coli,
LT exotoxin works. If you remember the LT, remember the E. Coli the toxigenic strain. The etec E.
coli. Some produced in the LT toxin of this xt toxin (?). LT being the heat-labile toxin. And as you
may recall that is the one e coli when they produce it. From tissues. From gut. They produce this
toxin LT. Adenocyclase to convert ATP into cyclic AMP. The increases, we dont need much cyclic
AMP in our cells to survive. Very few quantities. But if the levels go up of cAMP in our cells, this is
what happens in all of our cells of our guts during the infection of E. coli LT toxin produced. You
lose water. Thats where all this water comes from. And you lose water from these cells. Cells of our
body, our intestine. And all the salts leave as well. Other E. coli maybe they can prevent the
absorption of water. But LT we lose water from our own cells.

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So the toxin, cholera bacteria, is called choleragin. Once again it works the same as LT. and it is
much more potent than the LT toxin of E. coli. It is the same thing but you lose about a liter of fluid
every hour of Cholera. That is about 24 liters a day, 24 quarts of water you lose a day. So you get
lose of water, you get cells that are sloughing off. There are clumps of bacteria, clumps of cells. And
it leads to a condition known as Rice Water Stools very watery, buckets of water with specs of
bacteria cells debri. So they are referred to this particular sign known as Rice Water Stools.
He will probably talk about a couple different. One of particular type, Second serial type of Cholera
seems to be spreading throughout the world and as with any of these infections being two that are
gastroenteritis are from the best therapy. Not necessary an antibiotic because once they are there
doing this thing in your body doing this type of damage, you want to replace the fluid and the
electrolytes that are being lost. So you want to use something like for kids Pedialyte or Gatorade or
things like that. So fluid replacement therapy. Or oral rehydration is often better. Replace those
fluids. Keep the person comfortable and at the least try to get them to absorb as mucha so you can
the salts in the water that is in Pedialyte or in Gatorade. And I should say another one of these
things these solutions such as Pedialyte. What they do in parts of Africa. They have packets. Packet
of powder with these salts. And actually they often use, they add one sugar. Should remember two.
So these salts like sodium chloride, calcium chloride, magnesium etc ammonium sulfite, all these
things that are necessary and they should also have some sort of glucose in it as well. And you get
these packets that is kind of like Tang. I dont know if you have Tang anymore. Or just add even
dehydrated coffee. You just add that to water to solubalize it.. you can find somewhere in this
country where there are these outbreaks of cholera to find an area with clean water and you just
add these things and replenish the fluids and the salts. Glucose is there to help ourselves to absorb
the electrolytes. Help the absorption of these salts in the solutions that I use for therapy.

Anything else? Campylobacter, Helicobacter. Those are some of the more important things. Im sure
he has a lot more to say about them. I didnt send him a reminder this time to him to come. But I
certainly will tonight. He is supposed to back tomorrow afternoon for a couple hours of lecture. Any
questions about those three? (Laughter.) I didnt even bring my computer today. Im sure there are
some other important... I think if... Try to distinguish these infections in that way what is unique
about them. Those are the most important things. Such as the therapy used for Helicobacter pylori.
Anything unusual. Now, remember that. Okay Ill call him and well see you tomorrow.