• Because stools have numerous microbial flora, efficient screening methods must be used to recover any pathogens • Enteric pathogens include Salmonella, Shigella, Aeromonas, Campylobacter, Yersinia, Vibrio, and E. coli 0157:H7 Screening Stools for Pathogens (cont’d) • Most labs screen for Salmonella, Shigella, and Campylobacter; many screen for E. coli 0157:H7 • Fecal pathogens are generally lactose-negative (although Proteus, Providencia, Serratia, Citrobacter and Pseudomonas are also lactose- negative) Staphylococcal Food Toxin • S/S: Vomiting, severe cramping, low grade fever, diarrhea (no blood in stool) • Incubation: VERY short – 30 minutes to a few hours. • Complications: None, spontaneous recovery • Diagnosis: No specific test available. Clinical dx. Staphylococcal Food Toxin • Treatment: Supportive – rest, hydration, compazine or other antiemetic for persistent vomiting • Origin: Toxin producing S. aureus strains, usually from human skin, inoculate food, multiply at room temp. Toxins not destroyed by reheating. • Other toxin producing bacteria: Clostridium perfringens, Bacillus cereus. Staphylococcal Food Toxin • Prevention – Decrease food handling – Do not allow foods to sit at room temp. for long periods – Glove use by food handlers – Exclude persons from food handling when obvious skin infections are present. Vibrio cholera
• Gram negative bacteria,
• comma shaped, arrow shaped • Highly motile, • facultative anaerobic, • curved rods with one or more flagella • Non-invasive, remains in intestinal tract V. cholera Pathogenesis • Heat labile enterotoxin (MW) of 84,000 consisting A and B. • Enterotoxin increased cAMP hypersecretion of water and electrolytes increased sodium dependent chloride secretion absorption of sodium and chloride by the microvilli is inhibited • Electrolyte rich diarrhea (20 – 30 L/day) • Dehydration, shock, acidosis, and death • Rice stool diarrhea Treatment
Antibiotics = not necessary, but would hasten organism clearance.
Macrolides (erythromycin) and azithromycin, tetracylcine or doxycycline. Summary of bacterial gastroenteritis Viral Gastroenteritis • Most common cause of infectious diarrhea in US • Infect epithelium of small intestine • Diarrhea is watery • WBC’s and visible blood are rare • 4 categories: Rotavirus, Claicivirus (norovirus), Astroviurs, Enteric Adenovirus. Rotavirus • Most common cause of diarrhea in young children • Highly contagious: fecal-oral. • Incubation 1-3 days, lasts 4-8 days • Dehydration and hospitalization common in young children • Diagnose by EIA antigen in stool • Treat with oral rehydration or IV • Oral vaccine now available (controversial) Calcivirus • Infect older children and adults • Nonspecific, self-limiting • Large water-borne and food-borne outbreaks occur, fecal-oral • Incubation 24-48 hrs, lasts 12-60 hrs • No commercial tests to diagnose • Treatment supportive (oral rehydration) Viral causes Gastroenteritis virus vs bacterial