I.

Bacterial causes of
Diarrhoea
3. Campylobacter epidemiology

Characteristic

are : gram negative;

slender, spirally curved-rod, motile
(single polar flagellum)

Campylobacter

are important pathogens

in animals and in the past 10 years have
become the most frequent cause of
bacterial gastroenteritis in human, the
most common C.jejuni.

As

with Salmonella, there is a large

animal reservoir, so that infections are

3. Campylobacter Pathogenesis
Not

all infections are symptomatic, some

patients may become asymptomatic
excreters

The

incubation period is usually 2-5 days

(2-11 days), duration 3 days-3 weeks

Diarrhea

may be preceded by fever,

myalgia, and abdominal pain. Abdominal
pain mimic acute peritonitis. Vomiting
rare.

Diarrhea

lasts about 2-3 days but

abdominal pain may persist. Stool may
contain fresh blood, pus or mucus,

3. Campylobacter Lab. Diagnosis

and Treatment
Direct

examination of fresh by dark-field

or phase contrast microscopy can be
used in the diagnosis of Campylobacter
enteritis.

Selective

media with and without blood

have been used to isolate organism
from stool

Chemotherapy

is not warranted, and

erythromycin is the antibiotic of choice
for cases of diarrhoea disease that are
severe enough to treatment

3. Campylobacter Prevention
Prevention

of Campylobacter
infection is possible when (like
prevention salmonella):
1) water supply are purified
properly
2) milk for human consumption
is
heat-treated
3) there is hygienic handling of

4. Vibrio cholerae Introduction

Vibrio

are straight or curved rods

belong to the family Vibrionaceae
comma-shaped gram negative,
facultative anaerobes, that are
motile by a polar flagellum or
flagella.

The

most important of Vibrio is V.

cholerae, the etiological agent of
cholera

4. Vibrio cholerae Epidemiology

V.

cholera is free-living inhabitant of fresh

water but causes infection only humans

Asymptomatic

human carriers are

believed to be a major reservoir

The

disease is spread via contaminated

food; shelfish grown in fresh waters all
type of shelfish product may be the
source of infection

Thus

cholera continues to flourish in

communities where the provision of clean
dringking water and adequate sewage
disposal is absent or unrealible

4. Vibrio cholerae
Epidemiology
V.

cholerae can be subdevided

into serotype based on
somatic (O) antigen

Serotype

O1 is the most
important and it is further
devided into 2 biotype :
Classical and El Tor.

The

El Tor biotype differs from

4. Vibrio cholerae Pathogenesis

Vibrio cholerae O1 :
Cholera caused by V. cholerae O1
is spread from person to person by
ingestion of contaminated water or
uncooked foods, especially fish
M.o.

is very susceptible to gastric

secretion. Ingestion of 109 vibrios in
food or water is required to initiate
disease.

If

the individual s gastric content

have been neutralized by

4. Vibrio cholerae
Pathogenesis

The

incubation period for cholera is

approximately 2-3 days and is
followed by a period of vomiting and
diarrhea up to 7 days. 10-25 liters of
fluid may be lost during infection

Rapid

dehydration is accompanied
by loss of electrolyte such as
potassium and bicarbonate. The loss
of electrolytes is due to a microbial
enterotoxin

Protration

can occur at any time and

4. Vibrio cholerae
Pathogenesis
The

major causes of death in cholera are

shock, metabolic acidosis, and renal
failure

The

relationship between adherence

properties and pathogenesis has not
been clearly it is believe that
flagellum is s prerequisite to attachment
to the epithelial surface

The

flagellum enables the m.o. to

penetrate the mucous gel covering the
intestinal epithelial surface

4. Vibrio cholerae Pathogenesis

Once

attached to the epithelial

surface, the m.o. can multiply
and produce enterotoxin

Enterotoxin

is a protein
composed of A and B subunits.
The subunits B attach to receptor
dissociation of subunit and
entry of subunit A to plasma
membrane activation of
subunit A cause activation of

4. Vibrio cholerae
Pathogenesis
Increase

cAMP alters the ion

transport mechanism
associated with the
cytoplasmic membrane.

Permeability

changes
involving sodium (Na+) and
chlorine (CL-) cause an efflux
of water from the mucosal
surface and hence cause

4. Vibrio cholerae Pathogenesis

Vibrio cholerae non-O1 :

Non O1 organism produce a
cholera-like toxin that is believed
to beassociate with
gastrointestinal sympom,. Most
cases are sporadic, and not
associated with pandemics, as
classic cholera is
The

symptoms of non O1

4. Vibrio cholerae Lab.

diagnosis
In

country where cholera is

prevalent , diagnosis based on
clinical ground. Because ETEC
infection can resemble cholera an
its severity, so fluid and electrolyte
replacement are of important

For

diagnosis of sporadic and

detection of carriers , culture is
required to distinguish cholera from
other acute diarrhoeas

4. Vibrio cholerae
Treatment
Cholera

is a self-limiting disease when

water and electrolytes are replaced.

Prompt

oral or intravenous rehydration

with fluids and electrolytes is central to
the treatment of cholera.

replacement fluid consisting of NaCl,

sodium bicarbonate, and potasium
chloride can be given IV for patient in
severe shock

Oral

rehydration therapy for patient with

less severe disease includes the use of

4. Vibrio cholerae
Treatment

The addition of sugars permits fluid

balance in the gut by preventing
the loss of sodium

Antibiotic

are not necessaary , but

tetracycline may be given as some
evidence indicates that this
treatment reduces the time of
secretion of V. cholera thereby
reducing the risk of transmission

Tetracyclin

is used for adults while

trimetoprim-sulfamethoxazole and

4. Vibrio cholerae Prevention

As

with other diarrhoeal disease, a

clean drinking-water supply
adequate sewage disposal are
fundamental to the prevention of
cholera.

Be

possible to eliminate the disease

because there is no animal reservoir

killed, whole-cell vaccine is

available and is given parenterally,
but is only effective in about 50% of

5. Shigellosis
Introduction

Shigellosis

is also known as
bacillary dysenthry because in its
more severe form it is
characterized by an invasive
infection of the mucosa of large
intestine, causing inflammation
and resulting in pus and blood in
the diarrhoeal stool

However

symptoms range from

mild to severe depending on the

5. Shigellosis
Epidemiology
Thre are 4 species, of which Shigella
dysenteriae is the most serious.
Shigellosis

is primarily a paediatric disease.

When associated with severe malnutrition it
may precipitate complication such as the
kwashiorkor

Shigella

are human pathogens without

animal reservoir, being spread from
person-to-person by the fecal-oral route and
less frequently by contaminated food and
water

Shigella

able to initiate infection from a

small infective dose thus spread is easily

5. Shigellosis
Pathogenesis

Shigella are effective pathogen, cause

disease with doses as low as 10-100 m.o.;
whereas with Salmonellae, Campylobacter,
and V. cholera, higher doses are usually
required

Incubation periode 1-4 days, duration 2-3

days. Vomiting rare. The m.o. attach to and
invade the mucosal epithelium of the distal
ileum and colon, causing inflammation and
ulceration. Abdominal cramp and fever
positif

However

they rarely invade throught the

gut wall to the bloodstream. Enterotoxin is

5. Shigellosis Clinical
features,
Treatment, and
Diarrhoea
is usually watery at first but later
Prevention
contains mucus and blood. Lower
abdominal cramps may be severe

The

disease is usually self-limiting but

dehydration can occur, especially in the
young and elderly.
Complication may be associated with
malnutrition.
Treatment

: Rehydration may be indicated.

Antibiotic not be given except in severe
cases.

Prevention

: education in personal hygiene

6. Other bacterial causes of

diarrhoeal
disease Gram (-) and (+)
bacteria
The patogen described in the previous
are the major bacterial causes of
diarrhoeal disease

Salmonella

and Campylobacter
infection and some types of E. coli
infections are most often food
associated.

Cholera

is more often waterborne and

Shigellosis is usually spread by direct
fecal-oral contact.

There

are several other bacterial

6. Other bacterial causes of

diarrhoeal
disease Gram (-) and (+)
bacteria
Two Gram-negative bacteria which
have been associated with food-borne
outbreaks of diarrhoeal disease are :
Vibrio parahaemolyticus and Yersinia
enterocolitica
These

Gram-negative organism
previous, invade the intestinal mucosa
or produce enterotoxin which cause
diarrhea. None of, produce spores

Two

Gram-positive species are

important causes of diarrhoeal disease

Gram NEGATIVE bacteria :

1. Vibrio parahaemolyticus
Is

a halophilic (salt-loving) vibrio

contaminates seafood and
fish, if consume uncook causes
diarrhoeal disease

Most

strain associated with

infection are haemolytic by
production of a heat-stable
cytotoxin and shown invade
intestinal cell (in contrast to V.

Gram NEGATIVE bacteria :

1. Vibrio
parahaemolyticus
Incubation
period 8 hours-2
days, duration 3 days. Symptom
are diarrhoea, vomiting,
abdominal; cramp and fever
Diagnosis

laboratorium , must
provide adequate information
about the patients history and
food consumption to indicate to
that vibrios should be looked for.

Gram NEGATIVE bacteria :

2. Yersinia enterocolitica
Member

of the Enterobacteriaceae and is a

cause of food-associated infection,
particularly in colder parts of the world,
because m.o. prefers to grow at temp. 22 o 25o C.

Yersinia

enterocolitica is found in a variety

of animal host (rodent, pig, rabbit, sheep,
and domestic pets)

Transmission

to human from household

dogs has been reported.

M.o.

survive and multiply, more slowly at

refrigrator tem. (4o C), and has been

Gram NEGATIVE bacteria :

2. Yersinia enterocolitica
The

mechanism of pathogenesis is
unknown but the clinical feature of the
disease result from invasion of the
terminal ileum, necrosis Peyers patches
and an associated inflammation of the
mesenterica lymph node.

Incubation

periode 4-7 days, duration 12 weeks, symptom diarrhoea and

abdominal cramp, fever, rare vomiting

Lab.

Diagnosis as with V.
parahaemolyticus, an indication of

Gram POSITIVE bacteria :

1. Clostridium perfringens
C.

perfringens (C. welchi) is associated with

diarrhoeal disease in different circumstance
:
- enterotoxin-producing strain are a
common causeof food-associated
infection;
- much more rarely beta-toxin producing
strain produce an acute necrotizing
disease of the small intestinum,
accompanied by abdominal pain and
diarrhoea.

This

form occurs after consumption of

Gram POSITIVE bacteria :

1. Clostridium perfringens
Pathogenesis

C.perfringens have 2 form

of food-associated infection.
1. The common, enterotoxin-mediated
infetion is usually acquired by eating
meat that has been cooked enough to kill
vegetatif cells but not spora. As the food
cools the spore germinate. If re-heating
before consumption is in adequate,
large number of m.o. are ingested.
2. The rare form associated with betatoxin producing strain causes a severe

Gram POSITIVE bacteria :

1. Clostridium perfringens
Antibacterial

treatment of C.
perfringens diarrhoea is rarely required.

Prevention

depend on through reheating of food before serving, or

preferably avoiding cooking foodtoo
long in advance of consumption

C.

perfringens is also an important

cause of infection of wound and soft
tissue.

Gram POSITIVE bacteria :

2. Bacillus cereus
Spores

and vegetatif cells of Bacillus cereus

contaminate many food, and foodassociated infection take ones of twp form :

1. Diarrhoea resulting from the production

of enterotoxin in the gut
2. Vomiting due o the ingestion of
enterotoxin in food (emetic toxin)
Clinical feature : incubation periode for
Diarrhoea (8 hours-12 hours) and emetic
(15 mins-4 hours); duration for diarrhoea
12 hors-1 day) and emetic (12 hours-2
days). In type diarrhoea, diarrhoea with

Gram POSITIVE bacteria :

2. Bacillus cereus
Diagnosis

labor. : requires
specific media

Prevention

of Bacillus foodassociated infection depend on

proper cooking and rapid
consumption of food.

Treatment

: Spesific
antibacterial treatment is not