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Infectious Disease > Enterics I > Flashcards

Enterics I Flashcards

1
Q

Bacteria found in the intestine

A 
vibrionaceae 
- vibrio cholera
enterobacteriaceae
- E coli
- shigella
- salmonella
- yersinia
campylobacteriaceae
- campylobacter
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2
Q

summer food borne illness

A

campylobacter
salmonella
e coli

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3
Q

winter food borne illness

A

yersinia

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4
Q

infective doses of enteric pathogens - shigella

A

10-100 bacteria
most acid resistant
person to person

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5
Q

infective doses of enteric pathogens - salmonella

A

10^4 - 10^5

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6
Q

E coli infective dose

A

10^3 (EHEC)

10^8 (ETEC)

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7
Q

Vibrio cholera - infective dose

A

10^8

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8
Q

are infective doses increased or decreased by ingestion with food?

A

decreased

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9
Q

Gram negative antigenic structure

A

lipopolysaccharide - o-antigen

flagellum - h-antigen

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10
Q

medically relevant genetics of enterics

A

plasmids
bacteriophage conversion
chromosomal

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11
Q

plasmids and enterics

A

confer antibiotic resistance
pili
enterotoxins

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12
Q

bacteriophage conversion and enterics

A

toxins - shiga, cholera

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13
Q

chromosomal and enterics

A

pathogenicity islands

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14
Q

Piliated E. coli

A

ETEC strain

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15
Q

Noninvasive diarrhea

bugs? (4)

A

vibrio cholerae
ETEC
EPEC
EHEC

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16
Q

Invasive diarrhea

bugs (5)

A 
shigella
enteroinvasive e coli
salmonella 
yersinia
campylobacter
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17
Q

cholera transmission

A

estuarine and marine environments: shellfish

fecal-oral: water >food

in some cases person-to-person:
hyper infectious state
lowers infectious dose

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18
Q

vibrio cholera

virulence factors:

A

colonization: TCP co-regulated pilus
enterotoxin: cholera toxin

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19
Q

cholera toxin and diarrhea

A

profuse watery diarrhea - up to ONE LITER / hour

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20
Q

What is the major cause of Traveler’s diarrhea

A

ETEC

enterotoxigenic E coli

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21
Q 
ETEC 
virulence factors (2)
A 
adherence factors 
- colonization factor antigen
-- colonize small bowel
toxins
- heat labile enterotoxin (LT) related to cholera toxin
- heat stable enterotoxin (ST)
-- produce profuse watery diarrhea
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22
Q

ETEC clinical disease

A 
watery diarrhea
no blood or pus in stool 
rarely fever or vomiting
abrupt onset; usually self-limiting
may be cholera-like
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23
Q

EPEC

classic

A

watery diarrhea in children

developing world

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24
Q

EPEC

virulence factors

A 
adherence: bundling forming pilus
attaching and effacing lesion (eae locus)
- type III secretion system 
- translocated intimin receptor
- pedestal formation 
- loss of microvilli - malabsorption
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25
Q

T3SS system in E coli (epec)

A

stimulates colonic crypt hyperplasia and reduced respiratory capacity

O2 provides competitive advantage to E coli at the expense of normal microbiota

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26
Q

Enterohemorrhagic E coli
EHEC

lab and spread

A

O157:H7
Sorbitol non-fermenting

food borne
zoonotic disease: Ruminants (cows) serve as reservoir

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27
Q

EHEC

Virulence

A

Forms attaching/effacing lesions and pedestal formation
- expresses eae T3SS locus of EPEC

Shiga toxins:
AB toxins
Inhibit protein synthesis

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28
Q

EHEC

syndromes

A

initial watery diarrhea, cramps
2-3 days hemorrhagic colitis bloody diarrhea

6% HUS in children

  • acute renal injury and thrombocytopenia
  • severe in young and old
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29
Q

What are the 4 noninvasive enteric we learned about?

A

Vibrio
ETEC
EPEC
EHEC

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30
Q

Invasive enterics

what do they cause?

A 
penetrate the intestine
lower volume of stools - mucous and/or bloody 
more severe pain/cramps
fecal leukocytes
fever
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31
Q

what are the 5 invasive enteric we discussed?

A 
shigella
EIEC
salmonella
yersinia
compylobacter
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32
Q

Shigella dysteneriae - O antigen group and disease

A

A antigen grouping

dysentery - most severe Shiga toxin

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33
Q

Shigella flxneri
O antigen grouping
disease and severity

A

B antigen grouping

common - mild to severe

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34
Q

Shigella boydii
O antigen grouping
disease and severity

A

C antigen grouping

rare - mild to severe

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35
Q

Shigella sonnet
O antigen grouping
disease and severity

A

D antigen grouping
most common in the US
mildest watery diarrhea

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36
Q

Pathogenesis of shigella

invade?

A

invasion of colonic M cells

- type III secretory cells

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37
Q

Pathogenesis of shigella

apoptosis?

A

apoptosis of macrophages

  • type III secretory system
  • IL1 production
38
Q

Pathogenesis of shigella

entry?

A

entry of enterocytes
- type III secretory system
IL8 production

39
Q

Pathogenesis of shigella

Cell - cell spread

A

Type III secretion system

IcsA

40
Q

Pathogenesis of shigella

interleukins that attract PMN

A

IL1 and IL8

41
Q

Pathogenesis of shigellosis dysentery

A 
Massive invasion of epithelium 
Macrophage apoptosis 
Capsase I activation
Cell to Cell spread
Disruption of epithelial permeability barrier by PMNs
42
Q

Clinical disease of shigellosis

A

lower abdominal cramps
diarrhea
blood, mucus, and pus
fever

HUS
shiga toxin of S. dysenteriae

43
Q

Nontyphoidal salmonellae

2

A

Zoonosis
S. Tymphimurium
S. Enteritidis

44
Q

Nontyphoidal salmonellae comes from? causes?

A

food poisoining

watery diarrhea

45
Q

Nontyphoidal salmonellae
incubation
course
clinical

A

6-24 hour incubation
self-limiting gastroenteritis
fever
neutrophils

46
Q

Nontyphoidal salmonellae in HIV?

A

Disseminated

47
Q

Typhoidal salmonellae
character
2 types

A

human adapted
S. Type
S. Paratyphi

48
Q

Typhoidal salmonellae

clinical

A

enteric fever
systemic disease
fever

49
Q

Typhoidal salmonellae

incubation

A

1-3 week

50
Q

Typhoidal salmonellae

path

A

mononuclear phagocytes

51
Q

Typhoidal salmonellea can kill

A

immunocompetent people

52
Q

Virulence factors common to typhoidal and nontyphoidal salmonella

A

Attachment
Invasion
- Salmonella pathogenicity island 1 SPI1 type III secretion system
Survival in macrophages
- Salmonella pathogenicity island 2 SPI2 type III secretion system

53
Q

Invasion

- entry of salmonella typhimurium

A

triggers its own internalization into epithelial cells

  • adhesion fimbriae
  • forced uptake
  • pathogenicity island 1 (SPI1) type III secretion
54
Q

Salmonella survival and replication in vacuoles is mediated by the

A

SPI2 type III secretion system

55
Q

Salmonella Type specific virulence factors

A

Gall bladder biofilms - carriers
Capsule - immune evasion
A2B toxin - cytolethal distending toxin - DNase

56
Q

Capsule in salmonella
typhimurium
typhi
who has one?

A

typhimurium does not

typhi does

57
Q

Therapy for salmonella
Gastroenteritis
Typhoid fever

A

Gastro - no antibiotics unless immunocompromised

Typhoid fever - yes - vaccination - live attenuated - capsular antigen

58
Q

Campylobacter gram stain

A

Gull wing shaped
gram negative

small: filter enrichment
C jejuni > C coli

59
Q

campylobacter jejuni

when is common?

A

warmer months

60
Q

campylobacter jejuni

causes

A

most common cause of gastroenteritis in the west world

61
Q

c jejuni is outgrown by

A

other enterics - microaerophilic

62
Q

campylobacter epidemiology

A

zoonotic
- pets - sick puppies - cats

outbreaks are associated with raw milk or untreated water

prevalent in commercial poultry

  • meat product contamination during processing
  • antibiotic usage in poultry farms leads to increased resistance
63
Q

campylobacter

pathogenesis

A

colonize distal ileum and colon

motility - for penetration of intestinal mucus
- flagella are essential

invasive in vitro - tissue culture

toxins - cut-lethal distending toxin

induces inflammatory response

64
Q

symptoms associated with campylobacteriosis

A

cramps
fever
blood diarrhea
vomiting

fever and cramps most common

65
Q

vibrio cholerae

virulence factor

A

cholera toxin

66
Q

vibrio cholerae

target

A

adenylate cyclase

67
Q

ETEC

virulence factors

A

heat labile enterotoxin

heat stable enterotoxin

68
Q

ETEC

Heat labile enterotoxin target

A

adenylate cyclase

69
Q

ETEC

Heat stable enterotoxin target

A

guanylate cyclase

70
Q

EPEC

virulence factor and target

A

LEE T3SS

Pedestal formation

71
Q

EHEC

virulence factor and target

A

LEE T3SS - pedestal formation

Shiga toxin - hemorrhagic colitis, HUS

72
Q

Shigella spp.

Virulence factor and target?

A

T3SS - uptake, apoptosis, inflammation

73
Q

Shigella dysenteriae

Virulence factor and target?

A

T3SS, shiga toxin - uptake, apoptosis, inflammation, dysentery, HUS

74
Q

Nontyphoidal Salmonella

Virulence factor and Targets

A

SPI1 T3SS - uptake

SPI2 T3SS - intracellular survival, diarrhea

75
Q

Salmonella Typhi

Virulence factor and target

A

SPI1 T3SS, SPI2 T3SS - uptake, intracellular survival

Capsule, typhoid toxin - enteric fever, macrophages

76
Q

Campylobacter

virulence factors and target

A

flagella, cytolethal, distending toxin - epithelial cells

77
Q

What is the most common bacterial pathogen

A

H pyloric - acquired in childhood

78
Q

What does Helicobacter pylori do?

A

colonize gastric mucosa - without invasion

79
Q

H pylori is similar to campylobacter in what regard?

A

in morphology and growth requirements

  • microaerophilic
  • campy media without antibiotics
80
Q

H pylori pathogenesis

A

Highly motile - penetrates gastric mucus, colonize more neutral pH region close to epithelium

UREASE urea CO2 + NH3, neutralize acidity

Adheres tightly to epithelium - LPS resembles Lewis blood group antigens; Neutrophils

Toxins: vacuolating cytotoxin - VacA; epithelial damage

cag+ pathogenicity isalnd: gastric and duodenal ulcers inflammation

81
Q

Disease symptoms of H Pylori

A 
Gastritis 
Gastric ulcers 
Duodenal ulcers
MALToma
Gastric adenocarcinoma
82
Q

Vibrio cholerae ab therapy

A

tetracycline in severe cases

83
Q

ETEC ab therapy

A

fluoroquinolones

84
Q

EHEC ab therapy

A

No ab therapy

85
Q

Shigella ab therapy

A

Ciprofloxacin

86
Q

Nontyphoidal salmonella ab therapy

A

NO abs

ciprofloxacin in compromised hosts

87
Q

Typhoid fever ab therapy

A

ciprofloxacin, ceftriaxone

88
Q

Campylobacter

ab therapy

A

erythromycin

89
Q

helicobacter ab therapy

A

PPI, bismuth, clarithromycin, amoxicillin, metronidazole

90
Q

general enteric infectious therapy

A

fluid and electrolytes

Infectious Disease (5 decks)

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