MICROBIOLOGY

AND
PARASITOLOGY
Presentation
 Group Members

Ashly Azucena Maria Oltek

Sofia Minguela
Shaira Perez
 Topic
Topic 1: Small and Large Intestine

Topic 2: Bacterial Infection

 Diarrhea
In most cases, diarrhea is defined as a change in the normal bowel habitats of an
individual, with an increase in the frequency, fluidity, looseness, and volume of
feces excreted per day in comparison to the usual fecal output of the individual.
In a normal adult, the average daily stool weight is less than 200 grams, of which
65% to 85% is water. Diarrhea implies daily stool production in excess of 200
grams, containing 70% to 95% water it is the final common pathway of intestinal
responses to many inciting agents and serves as an adaptive mechanism
developed by the body to get rid of noxious material.

Shai
Diarrhea may be classified as invasive or non-invasive.
Non-invasive diarrhea is the result of disruption of the secretory process due to
the toxin release from the bacteria. This characterized by watery diarrhea and
the absence of blood or leukocytes in the feces. In invasive diarrhea there is
direct damage to the gastrointestinal tissues due to direct invasion by the
bacteria. It is characterized by fever, dysentery (blood in stools), and
leukocytes in feces.
Rehydration or replacement of fluid and electrolytes lost is necessary for the
management of any form of diarrhea. Fluid replacement can be done by drinking
more fluids or oral rehydration solution (ORS) or through IV depending on the
severity of dehydration. Some suggest giving of zinc supplement reduces the
severity of diarrhea. A new concept in the management of diarrhea is the use of
probiotics. Some claim that probiotics are helpful in preventing traveler's diarrhea in
the children and antibiotic-associated diarrhea.
MODE OF TRANSMISSION

The most common mode of transmission is fecal-oral transmission. This includes

(1) person-to-person transmission, usually in association with overcrowding and
poor personal hygiene, (2) ingestion of contaminated meat, poultry produces or
seafood, and (3) contamination of food during or after cooking.
 Viral Gastroenteritis

Acute, self-limited infectious

diarrhea which usually involves
children, is most commonly caused by
enteric viruses. It may cause severe
dehydration requiring hospitalization ,
especially in infants.
Rotavirus is the most common viral cause of gastroenteritis in children. Infants
and young children are most commonly affected although debilitated adults may
be susceptible. It destroys mature enterocytes leading to loss of absorptive
function of the small intestine with net secretion of water and electrolytes.
Outbreaks me occur in the pediatric population in hospital and daycare centers.
After incubation period of approximately 2 days, vomiting and watery diarrhea
will occur for several days.
Norwalk virus is responsible for majority of cases of non-bacterial food-
borne epidemic gastroenteritis with watery diarrhea, abdominal pain, nausea,
and vomiting. Outbreaks may occur following exposure of multiple
individual to a common source. Majority of outbreaks can be seen in nursing
homes. There are no specific treatments for viral gastroenteritis. Management
is mainly supportive with adequate fluid and electrolyte replacement.
 Bacterial
Infections
 Bacterial Enterocolitis (Food Poisoning)

A classic case of food poisoning has two important features: (1) similar symptoms occur
in several members of a group who share the same milk, (2) onset of symptoms occurs a
few hours after food ingestion.

Food poisoning may occur due to either of the three mechanisms:

1. Ingestion of preformed toxin- the preformed toxin may be present in contaminated food.
Major offenders are staphylococcus aureus, Vibrio and Clostridium perfringens. Symptoms
develop within hours consisting of explosive diarrhea and acute abdominal pain.
2. Infection by toxigenic organisms- the organisms proliferate in the gut lumen
and elaborate an enterotoxin. Symptoms occur within hours consisting of
diarrhea and dehydration if it involves a secretory enterotoxin, or dysentery if the
primary mechanism is a cytotoxic.

3. Infection by enteroinvasive organism- the organisms proliferate, invade and

destroy mucosal epithelial cell, leading to dysentery.
 Bacillus Cereus
The organisms are gram-positive aerobic rod or bacillus. Bacillus cereus
is mildly pathogenic and of low virulence hence an opportunistic
pathogen. Food poisoning caused by B. Cereus has two distinct forms:
the emetic type, associated with fried rice , and the diarrheal type,
associated with meat dishes and sauces. The organism produces toxins
and cause disease that is more of an intoxication than of food-borne
infection.
Clinical Findings

The emetic form is manifested by nausea vomiting abdominal cramps and

occasionally diarrhea. It is self-limited with recovery occurring within 24
hours. It begins 1-5 hours after ingestion of contaminated rice and occasionally
pasta dishes. The diarrheal form has an incubation period of 1-24 hours and is
manifested by profuse diarrhea with abdominal pain and cramps. Vomiting may
occur but is uncommon. The enterotoxin may be preformed or produced in the
intestine.
Laboratory Diagnosis
Laboratory diagnostic procedures
are usually not done , although
isolation of the organism from the
suspected food samples followed
by culture can be performed.
Treatment and Prevention
No antibiotic therapy is required since
the infection is self-limiting.
Prevention measures include
preventing contamination of food by
soil since the organism is usually found
in soil. Rice should not be kept warm
for long periods.
.
 Staphylococcus Aureus
S. aureus is an important cause of food poisoning and causes of food poisoning with the shortest
incubation period (30 minutes to 8 hours , average of 2 hours). Enterotoxins are produced when
the organisms grows in the food rich in carbohydrates and protein.

Mode of Transmission
The major mode of transmission for staphylococcus food poisoning is ingestion of the preformed
heat-stable toxin in contaminated food, is especially salad, custards, new products and processed
meat. The bacteria can grow in high salt concentration hence its association with processed meats.
The bacteria can be killed by reheating the food , however , it does not destroy the toxin. The chief
sources of infection are carriers and those individuals shedding human lessons , fomites
contaminated from such lesion , and the human respiratory tract and skin.
Clinical Findings

Vomiting accompanied by nausea is more prominent than diarrhea. The emetic effects
are probably the result of stimulation of vomiting center in the central nervous system
after the toxin acts on neutral receptors in the guts. There is no fever and rapid
convalescence is the rule.

Laboratory Diagnosis

Isolation of the organism from the suspected food samples followed by culture can be
performed to confirm the diagnosis. Contaminated food can also be tested for the
presence of toxin , however , this is seldom done.
Treatment and Prevention

Management is mainly supportive with the replacement of lost fluid and

electrolytes as a mainstay. No antibiotic therapy is required since the infection
is self -limited. Cleanliness ,
hygiene , and a septic management of lesion can control the spread of
staphylococci from skin lesions.
 Clostridium Perfringens
C. Perfringens is a large , rectangular gram-positive rod. It is an aerobic and rarely
produces spores. An enterotoxin produced by these microorganism is common cause
of food poisoning.

Mode of Transmission

Ingestion of preformed toxin from food contaminated with soil contaminating the
microorganism's spores such as reheated foods like meat dishes is the most common
means by which the organism is acquired.
Clinical Findings

The incubation period is 8-24 hours. The disease is characterized by watery diarrhea with
abdominal cramps. Vomiting may also occur but not common. The disease usually revolves in 24
hours.

Laboratory Diagnosis

Large number of the organism can be isolated from food samples. This is no assay for the toxin.

Treatment and Prevention

No antibiotic therapy is needed and management is mainly supervised. Food should be adequately
cooked before consumption to kill the organism and prevent infection.
 Vibrio Parahaemolyticus
V. Parahaemolyticus is a marine organism. It is a curve , gram negative
coccobacillus. Virulent strains produce kanagawa hemolysin, an enterotoxin
similar to the cholera toxin. It possesses polar flagella and pili. V.
Parahaemolyticus is the most common cause of bacterial gastroenteritis
associated with seafood.

Mode of Transmission

The infection is acquired to ingestion of raw or uncooked seafood, specially

shellfish such as oyster.
Clinical Findings

The manifestations vary from mild to severe watery diarrhea , nausea,

vomiting, abdominal cramps , and fever. The illness is self-limited , lasting
about three days.

Laboratory Diagnosis

Diagnosis can be confirmed by culture. The organism is halophilic ,

requiring 8% sodium chloride (NaCl) solution for growth.
Treatment and Prevention

antibiotic therapy is not

necessary because the disease is
relatively mild and self-limited.
Diseases prevented by proper
refrigeration and cooking of
seafood.
 Gastroenteritis (Diarrhea)
Infectious diarrhea may result from multiplication of the microorganism in
the gastrointestinal tract and the mobilization of host defenses as it
attempts to eliminate invading organism. All diarrhea producing bacteria
adhere to intestinal mucosal cell by means of fimbriae. Once bacteria
Start to proliferate , they can (1) induce structural abnormalities resulting
to increase excretion of fluids and electrolytes; (2) release toxins; or (3)
invade intestinal mucosa.
Bacteria producing diarrhea may be classified into invasive and non-
invasive bacteria. Non-invasive bacteria produced diarrhea by
producing enterotoxins or cytotoxins. Enterotoxins stimulate
adenylate cyclase causing fluid secretion , leading to a watery type
of diarrhea. Cytotoxins can cause tissue damage leading to
inflammation of blood loss. Invasive bacterial penetrate the bowel
epithelium, stimulating intense inflammation. There is direct damage
to the intestinal mucosa resulting dysenteric type of diarrhea.
 Escherichia Coli
E. Coli is a gram-negative , motile, encapsulated rod that is a member of
family Enterobacteriaceae and is a member of the normal intestinal flora.

Five pathogenic groups of E.Coli:

(1) enterotoxigenic E. Coli

(2) enteropathogenic E. coli
(3) enteroaggregative/ adherent E. coli
(4) enterohemorrhagic E. coli
(5) enteroinvasive E. coli.
Ashly
E. Coli is the most common cause of urinary tract
infection and gram-negative sepsis. It is the most
common cause of neonatal meningitis and is most
frequently associated with "traveler's diarrhea". Also
used as index of fecal contamination of water
The microorganism has several components that contribute to its
ability to produce disease. This includes the presence of pili
(where adherence), capsule ( anti-phagocytic ), endotoxin and
enterotoxin ( to that cause watery diarrhea and one that cause
bloody diarrhea and hemolytic-uremic syndrome.
 Enterotoxigenic E. Coli ( ETEC)
ETEC is major cause of "traveler's diarrhea" or "turista" and is an
important cause of diarrhea in infants in developing countries.
Some strains produce a eat-labile (LT) exotoxin that causes intense
and prolong hypersecretion of water and chlorides and inhibits
sodium reabsorption. Some produced a heat stable (ST)
enterotoxin that stimulates fluid secretion. Strains with both toxins
produced severe watery diarrhea. A more serious infection may be
observed in infants.
 Enteropathogenic E. Coli (EPEC)
EPEC is an important cause of diarrhea in infants in developing
countries. It was previously associated with outbreaks of diarrhea in
nurseries in developing countries. The organism adheres to mucosal
cells of the small intestine and cause loss of microvilli. This leads to
watery diarrhea that is usually self-limited but can be chronic.
Dehydration , electrolytes imbalance comma and other complication
may cause that so that antibiotic therapy is necessary.
 Enteroaggregative E. Coli (EAEC)

EAEC causes acute and chronic diarrhea. These are common

causes of foodborne illness in industrialized countries. EAEC
produces ST- like toxin and a hemolysin.
 Enteroinvasive ( EIEX)
EIEC causes invasion of the colonic mucosa. The disease occurs
most commonly in children and travelers in developing country.
The disease characterized by acute bloody diarrhea with malaise ,
headache , high fever , and abdominal pain. It is an operational
cost of occasional outbreak of dysentery and sporadic infection. It
is the most common cause of urinary tract infection as well as
meningitis in newborns.
 Enterohemorrhagic E. Coli (EHEC)
EHEC produces a shiga-like toxin as that produced by shigella. It is a
verotoxin that is cytotoxic , neurotoxic , and enterotoxin. The main source
of infection is undercooked meat , especially undercooked burgers in fast
food restaurants. It is associated with hemorrhagic colitis, a severe type of
diarrhea which initially presents with bloody diarrhea , vomiting , and
severe abdominal pain. It is also associated with hemolytic uremic
syndrome, a disease resulting in acute renal failure , hemolytic anemia ,
and thrombocytopenia ( low platelet count.
Laboratory Diagnosis

Diagnosis can be confirmed by culture of organism from stool specimen

using a different medium ( EMB or MacConkey's agar). On EMB agar ,
E. coli colonies have a characteristic greenish metallic sheen. E. coli can
ferment lactose. Biochemical test should be done to differentiate it from
the other members of enterobacteriaceae.
Treatment and Prevention

Antibiotic therapy is usually not indicated in E. coli diarrheal

disease. Trimethoprim-sulfamethoxazole can be given to
certain symptoms and eliminate the invasive forms of the
organism. Fluid and electrolytes replacement is essential.
Travelers diarrhea can sometimes be prevented by the
prophylactic use of doxycycline, ciprofloxacin, or
trimethoprim-sulfamethoxazole. Ingesting uncooked food and
unpurified water should be avoided while traveling in certain
countries.
Salmonella spp.
Salmonella is gram-negative , incapsulated , motile rod that also
belong to the family Enterobacteriaceae. The organism has three
important antigens-- cell wall ( somatic) O, flagellar H, and capsular
Vi ( virulence) antigens. The H antigen is responsible for the
invasiveness of the organism while the Vi antigen is anti-
phagocytic. Gastric acid is an important host defense. A large
inoculum is needed to produce infection.
Categories of salmonella

•The typhoidal species

• Non- typhoidal species

Mode of Transmission

Ingestion of food and water contaminated by human and animal

waste is the major mode of transmission. S. typhi is transmitted
only by humans. All other species have both animal and human
reservoirs.
Clinical Findings

1. Enterocolitis-characterized by invasion of the small and

large intestine. It begins with nausea and vomiting which
progresses to abdominal pain and diarrhea ( mild to
severe, with or without). The disease usually lasts a few
days and self-limited. This is the most common
manifestation of salmonella infection.
2. Typhoid or enteric fever- begins in the small intestine but few
gastrointestinal symptoms occur. Survival and growth of the organism
is phagocytic cells is a striking feature of the disease as well as the
predilection to invade the gallbladder , resulting in the establishment of
a carrier asymptomatic carriage of the bacteria for more than one year.

typhoid fever is the most common cause by S. typhi but can also caused
by S. Paratyphi. The illness is characterized by slow onset with fever ,
bradycardia and constipation rather than vomiting and diarrhea. After
the first week , as the bactermia occur. The disease begins to resolve by
the third week.
3. Septicemia- increase in one of two settings: if patients with
underlying disease ( sickle cell anemia) park answer , or a child
with the enterocolitis. Septicemia is most commonly caused by
S. Cholerasuis. Symptoms begin with fever with little or no
enterocolitis then proceed to focal symptoms. Osteomyelitis ,
pneumonia coma and meningitis are most common sequelae.

Laboratory Diagnosis

1. Enterocolitis- stool exam , stool smear , stool culture.

2. Typhoid fever or Enteric fever

a. Isolation and identification

Culture is the best method ( EMB or MacConkey's agar)
• Blood or bone marrow- 1st to 3rd week of illness
• Stool or rectal swab- incubation period; 2nd to 4th week of illnes.
•Urine - first two weeks

b. Serology- widal test

• positive only 24%- 60%; positive after the first week of illness.
• Measures level of antibodies against the O, H,Vi antigens.
• Interpretation:
Antibody against O Ag- acute infection
Antibody against H Ag- recovery or previous vaccination
Antibody against- Vi Ag- carrier

c. Typhidot- detects specific antibodies against salmonella

3. Biochemical tests are done to differentiate from other

Enterobacteriaceae
Treatment and Prevention

Enteric fevers and bactermia required antimicrobial treatment, however , vast majority of cases
of enterocolitis do not. Clinical symptoms and excretion of the microorganism may be
prolonged by antimicrobial therapy in enterocolitis. Antimicrobial therapy for invasive
salmonella is done using ampicillin, trimethoprim-sulfamethoxazole, 3rd generation
cephalosporin. In most carriers , surgical removal of the gallbladder (cholecystectomy) must be
combined with drug therapy.

Sanitary measures must be undertaken to prevent contamination of food and water. Through
cooking of infected poultry , meat , and egg must be done. Carriers must be treated promptly
and not be allowed to handled food , as well as observe strict hygiene precautions. Vaccines are
available to prevent the infection , especially in endemic areas.
 Shigella spp.
Shigellae are gram-negative , non-motile , non-encapsulated rod which are
members of family Enterobacteriaceae. The natural habitat is limited to the
intestinal tracts of human and other primates. There are four important
species of Shigella, namely S. Sonnei, S. Flexneri, S. Boydii, and S.
Dysenteriae type 1( Shiga bacillus). Of the four species,S. Dysenteriae is
the most common clinically significant as it is responsible for epidemics
with high mortality. The major virulence factors of S. dysenteriae type 1 is
shiga toxin, which is a verotoxin as in E. Coli. Low inoculum is needed to
produce infection.
MODE OF TRANSMISSION

Shigellosis is transmitted by 4 F's

•Food
• Fingers
•Flies
•Fomites
It may also be transmitted through sexual contact
CLINICAL FINDINGS

shigellosis is characterized by a short incubation of 1-3 days. It this characterized by lower

abdominal pain , fever , and bloody , mucoid diarrhea.

LABORATORY FINDINGS

1. Stool examination revealing leukocytes (wbc) and /or red blood cells in fresh stool specimen.
2 Culture of feces or rectal swad specimen (EMB or MacConkey's agar)

TREATMENT AND PREVENTION

The mainstay of management is fluid and electrolyte replacement. Antimicrobial agents such as
ciprofloxacin, ampicillin, doxycycline, and trimethoprim- sulfamethoxazole are effective against
the organism
 Yersinia Enterocolitica
Y. Enterocolitica also is member of the family Enterobacteriaceae and are
gram - negative, urease-positive rod .Urease produced by the organism utilizes
the gastric acid allowing the organism to survive and colonies intestine.

MODE OF TRANSMISSION

Ingestion of food ( meat and dairy products) or water contaminated by feces

or domestic animal is the primary mode of transmission. The organism may
also be transmitted through fomites.
CLINICAL FINDINGS

The organism causes inflammation and ulceration in the tissues affected. Early
symptoms include fever , abdominal pain , and diarrhea that is watery to bloody.
The terminal ileum may be involved and if the mesenteric lymph nodes are
involved, it may present itself as right lower quadrant pain and may be diagnosed
as acute appendicitis. 1 to 2 weeks after onset , some patient develop arthralgia ,
arthritis , and erythema nodosum. The organism , is rare instances , may cause
pneumonia , meningitis , or sepsis. It is however a self-limiting infection
LABORATORY DIAGNOSIS

Y. Enterocolitica grow in most culture media and can grow best with"
cold enrichment" or at low temperature of 4 degrees Celsius.

TREATMENT AND PREVENTION

most cases of diarrhea are self-limited and do not required antimicrobial
therapy. There are no specific preventive measures, however ,
preventing contamination of food and water may be helpful in
preventing infection.
 Vibrio Cholerae
The Vibrios are among the most common bacteria in surface of water worldwide. V.
Cholerae is a comma-shaped, curved, motile rod with the polar flagellum. V.
Cholerae produces an enterotoxin (choleragen or cholera toxin) that stimulates
prolonged hypersecretion of water and electrolytes. It is pathogenic only for
human.

MODE OF TRANSMISSION
the disease is spread by ingestion of contaminated food and water. Person-to-person
transmission is rare because the infectious dose is very high.
CLINICAL FINDINGS

the disease is called cholera and majority of cases are

asymptomatic. There is sudden onset of nausea and vomiting,
and profuse watery diarrhea. ( As much as 20-30 L/day) with
abdominal cramps. The stools may resemble "rice water". There
is severe dehydration which can lead to circulatory collapse and
hypovolemic shock may result in death if the patient is not
treated promptly.
TREATMENT AND PREVENTION

Crucial to the management of cholera is rapid fluid and electrolyte

replacement. The drug of choice tetracycline. Preventive measures
include help education in improvement of sanitation. Isolation of
patients which disinfection of their excreta should be a vaccine is
available , however , it provides limited protection to heavily expose
person and is not effective in epidemic control.
 Clostridium Perfringens
C. Perfringens is a toxin producing organism that can produce invasive
infection. It produces numerous toxins and enzyme that result in a spreading
infection. These toxins have lethal, necrotizing , and hemolytic properties.
Some strains produce a powerful enterotoxin, especially when grown in meat
dishes.

MODE OF TRANSMISSION

infection is human occur after ingesting food (usually meet in gravies)

contaminated by dirt or feces.
CLINICAL FINDINGS

C. Perfringens can produce a disease process called enteritis necroticans, an acute necrotizing
process in the small intestine that manifest with abdominal pain and bloody diarrhea. Severe
infection can lead to peritonitis and shock.

LABORATORY DIAGNOSIS

Diagnosis is done through culture under anaerobic conditions.

TREATMENT AND PREVENTION

The antimicrobial agent of choose is penicillin. Antitoxin in the form of concentrated
immune globuline can be administered. There are no specific preventive measures. Food
must be adequately cooked before consumption to kill the organism.
 Clostridium Difficil
C. Difficil is also an anaerobic , gram-positive , spore-forming rod. Approximately
3% of the general population are asymptomatic areas of the organism in the
gastrointestinal tract.It is the most common nosocomial cause of diarrhea. The
organisms produce exotoxins that cause death of enterocytes.

MODE OF TRANSMISSION

C. Difficil is transmitted by the fecal-oral route and hospital personnel are important
intermediaries.
CLINICAL FINDINGS

The organism cause antibiotic-associated pseudomembranous colitis. Clindamycin is the first antibiotic
recognized as a cause the disease but other antibiotics are now implicated. The second and the third
generation cephalosporin a are now considered as the most common causes. The diarrhea may be watery or
bloody infrequently accompanied by abdominal cramps , fever, leukocytes is.

LABORATORY FINDINGS

Direction of toxin in stool specimen using ELISA cytotoxicity test is a best basis for the diagnosis.
Sigmoidoscopy may also be done to visual the pseudomembrane

Treatment ang Prevention

Discontinuance of administration of the offending antibiotic is the treatment of choice followed by oral
administration of either metronidazole or vancomycin. Fluid replacement is essential.
BACILLUS ANTHRACIS
Gastrointestinal anthrax is very rare and is acquired by entry of spores through
the mucous membranes or by ingestion of improperly cooked meat from
infected animals. Symptoms include vomiting, abdominal pain and bloody
diarrhea.

The drug of choice for the treatment of anthrax is ciprofloxacin. Doxycycline id

an alternative drug. Control measures include: (1) proper disposal of animal
carcasses, (2) decontamination of animal products, and (3) active immunization
of domestic animals with alternative vaccine.
 Mycobacterium Tuberculosis

Tuberculosis of gastrointestinal tract can be caused by either M. Tuberculosis when it

is swallowed after being coughed up from a lung lesion or by M. Bovis when it is
ingested in unpasteurized milk product. It is characterized by abdominal pain and
chronic diarrhea, accompanied by fever and weight loss. Intestinal obstruction or
hemorrhage may also occur. Oropharyngeal tuberculosis typically presents with
painless ulcer accompanied by lymphadenopathy. Po H

Treatments involves multidrug therapy against the microorganism. The BGC vaccine
can be used to induce partial resistance to tuberculosis.