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BMD 330 Chapter 23 - Infectious Diseases Manifesting in the Gastrointestinal Tract

front 1

What are the eight main segments of the GI tract?

back 1

Mouth, Pharynx, Esophagus, Stomach, Small Intestine, Large Intestine, Rectum, and Anus

front 2

What are the four accessory organs of the GI tract?

back 2

Salivary Glands, Liver, Gallbladder, and Pancreas

front 3

What are the defenses against microorganisms in the GI tract?

back 3

  • Layer of mucus coating intestinal surfaces
  • Secretory IgA
  • Peristalsis keeps microbes moving
  • Saliva (includes lysozyme, lactoferrin)
  • Stomach (has extremely low pH)
  • Bile is antimicrobial
  • GALT (gut-associated lymphoid tissue) - Includes Peyer's patches and isolated lymphoid follicles

front 4

Describe the normal biota of the oral microbiome

back 4

  • Dominated by bacterial species
  • Methane-producing archaea
  • Fungi (Candida albicans is the most common)
  • Few protozoa species
  • Virome is still being studied

front 5

Describe the normal biota of the gut microbiome, specifically the esophagus and stomach

back 5

  • Consists of 200 different species
  • Most common types belong to Firmicutes (Streptococcus, Staphylococcus, Clostridium, and Bacillus species)

front 6

Describe the normal biota of the gut microbiome, specifically the large intestine

back 6

  • The large intestine is known to have billions of microorganisms (10^11)
  • Includes bacteria, fungi, and several protozoa

front 7

Describe the normal biota of the accessory organs

back 7

Accessory organs (salivary glands, pancreas, liver, gallbladder) are free of normal biota

front 8

What are the three functions of normal gut biota?

back 8

  • Protective function
  • Teach immune system to react properly to microbial antigens
  • Aid digestion and provide nutrients that we cannot produce ourselves

front 9

True or False: A diverse gut microbiome is associated with better health

back 9

True; When the gut microbiome loses its diversity, deviations from gastrointestinal -- and systemic -- health can occur. Disruptions may come from antibody treatment, illness, pregnancy, or dietary changes.

front 10

Saliva, sIgA, lysozyme, tonsils, and adenoids are defenses of the _________.

back 10

Oral Cavity

front 11

GALT, lymphoid tissue, Peyer's patches, appendix, sIgA, and rich normal biota are defenses of the ________

back 11

rest of the GI tract

front 12

Dental Caries (AKA tooth decay)

back 12

  • Most common infectious disease of human beings
  • Dissolution of the tooth surface due to the metabolic action of bacteria (results in minor to complete disruption of enamel; destruction of deeper layers can result in infection of the pulp)

front 13

Main causes of dental caries (AKA tooth decay)

back 13

Streptococcus mutans and S. sobrinus

front 14

The pulp contains _______

back 14

Blood vessels and nerves

front 15

_____ ___ dissolves the enamel of the tooth.

back 15

Lactic Acid

front 16

What are some stages in the development of dental caries?

back 16

  • Incidence of dental carries varies according to carbohydrate consumption, oral hygiene, and genetic factors
  • Streptococci produce sticky polymers of glucose, called fructans and glucan, aiding in the formation of plaque biofilm

front 17

Stages in Plaque Development and Cariogenesis

back 17

The bacteria forms a biofilm (can be made of multiple bacteria and some fungi) called plaque which is usually fuzzy.

front 18

The initial stage of periodontal disease is ______

back 18

Gingivitis

front 19

What are the signs of gingivitis?

back 19

  • Swelling
  • Loss of normal contour
  • Patches of redness
  • Increased bleeding

front 20

What are some other signs of periodontisis?

back 20

  • Development of spaces or pockets between tooth and gingiva
  • Disease extends into the periodontal membrane and cementum
  • Deeper involvement increases the size of pockets, causes bone resorption, and tooth loss

front 21

Stages in Soft Tissue Infection, Gingivitis, and Periodontitis

back 21

front 22

An individual's risk for dental caries or periodontitis is directly related to:

back 22

  • Presence of Methanobrevibacter oralis
  • Behavior (lack of flossing will put you at risk)
  • Genetic influences
  • Tooth position
  • Presence of mineralized plaque called calculus

front 23

The most severe form of periodontal disease is ___________________________ which progresses to ___________________.

back 23

Necrotizing Ulcerative Gingivitis; Necrotizing Ulcerative Periodonitis

front 24

What is the difference between NUG and NUP?

back 24

NUP is associated with advanced bone destruction

front 25

What is commonly referred to as "trench mouth" reflecting the poor dental health of soldiers in World War l?

back 25

Necrotizing Ulcerative Gingivitis and Periodontitis

front 26

Signs and symptoms of NUG and NUP

back 26

  • Severe pain, bleeding, pseudomembrane formation, and necrosis
  • NUP is associated with advanced bone destruction

front 27

An infection in the accessory salivary glands ______.

back 27

Mumps

front 28

What is Mumps caused by?

back 28

Paramyxovirus (A single-stranded RNA virus)

front 29

What are some signs and symptoms of the Mumps?

back 29

  • Fever, nasal discharge, muscle pain, malaise
  • Followed by inflammation of the salivary glands, producing swelling of cheeks

front 30

Mumps is associated with a distinctive and painful swelling ____.

back 30

At the angle of the jaw

front 31

What is the average incubation period for Mumps?

back 31

2-3 weeks

front 32

True or False: Viral multiplication in salivary glands is followed by invasion of other organs, especially the testes, ovaries, thyroid gland, pancreas, meninges, heart, and kidney.

back 32

True

front 33

What are some complications of Mumps?

back 33

  • Can invade other organs: testes, ovaries, thyroid glands, pancreas, meninges, heart, and kidney
  • Occurs in 20%-30% of young adult males where infection localizes in the epididymis and testes; does not cause sterility.

front 34

What are some effects of paramyxoviruses?

back 34

  • It causes cell to cell fusion, causing giant cells that are multi-nucleated.
  • A virus-infected cell is modified by the insertion of proteins called HN spikes into its cell membrane. The HN spikes immediately bind an uninfected neighboring cell, and in the presence of another type of spike called F spikes, two cells permanently fuse.
  • A chain reaction of multiple cell fusion then produces a syncytium with cytoplasmic inclusion bodies, which is useful for diagnostic.

front 35

____ is a sharp or burning pain emanating from the abdomen.

back 35

Gastritis

front 36

_________ are lesions in the mucosa of the stomach or uppermost portion of the small intestine.

back 36

Gastric or Peptide Ulcers

front 37

Severe ulcers can be accompanied by:

back 37

Bloody stools, vomiting, or both

front 38

When are symptoms of gastritis the worst?

back 38

Worse at night, after eating, or under conditions of psychological stress

front 39

What is the causative agent of gastritis and gastric ulcers?

back 39

Helicobacter pylori

front 40

Is Helicobacter pylori gram-negative or positive? What is the morphology of H. pylori?

back 40

Gram-Negative; Rod

front 41

The best treatment of gastritis and gastric ulcers is: _____________.

back 41

Clarithromycin

front 42

How is gastritis and gastric ulcers transmitted?

back 42

Oral-Oral; Fecal-Oral

front 43

Urea breath test is one way to diagnose _____________.

back 43

H. pylori

  • This test is a noninvasive method in which patients ingest urea that has radioactive tag on the carbon molecule. If Helicobacter is present, the bacterium's urease breaks down the urea and the patient exhales the radioactively labeled carbon.

front 44

True or False: Acute diarrhea can occur without vomiting.

back 44

False; Acute diarrhea can occur with or without vomiting.

front 45

Diarrhea is defined as ____ or more loose stools in a __-hour period.

back 45

Diarrhea is defined as 3 or more loose stools in a 24 hour period.

  • In the United States: average of 1.2 to 1.9 cases per person per year
  • A third of cases are transmitted by contaminated food
  • In tropical countries, children experience more than 10 episodes per year
  • More than 700,000 children die from diarrhea per year, mostly in developing countries

front 46

The most common and deadliest cause of foodborne illness in the United States is ________

back 46

Salmonella

front 47

Is Salmonella (S. enterica) gram-negative or positive?

back 47

Gram-Negative

front 48

What antigens are used to identify gram-negative enterics?

back 48

  • H - flagellar antigen
  • K - Capsular antigen
  • O - Cell wall antigen, the polysaccharide portion of LPS

front 49

Salmonella is motile... which means...

back 49

  • They ferment glucose with acid and sometimes gas; and most of them produce hydrogen sulfide (H2S) but not urease.
  • Grow readily on most laboratory media and can survive outside the host in inhospitable environments, such as freshwater and freezing temperatures.
  • Resistant to chemicals such as bile and dyes, which are the bases for isolation on selective media.

front 50

What is a common factor of all salmonella?

back 50

They are acid producers

front 51

What are some signs and symptoms of Salmonella?

back 51

  • Causes a variety of diseases resulting in 1 million cases and 400 deaths a year
  • Salmonellosis - Enteric fever or gastroenteritis (can range from mild gastroenteritis such as vomitting, diarrhea, and mucosal irritation to fever and septicemia)
  • Typhoid fever - Produced by a specific Salmonella; Salmonella enterica serotype Typhi
  • Ability to cause disease is dependent on its ability to adhere to the gut mucosa (has a high ID50; many organisms have to be ingested for disease to result)

front 52

How can Salmonella be prevented?

back 52

The only prevention for salmonellosis is avoiding contact with the bacterium.

front 53

What is an important virulence factor for Salmonella?

back 53

Endotoxin

front 54

Is Shigella gram-negative or positive? What is the morphology of Shigella?

back 54

Gram-Negative; Straight Rod

front 55

Salmonella is ____ whereas Shigella is ____.

back 55

Motile; Nonmotile

front 56

What does nonmotile mean?

back 56

Unable to form endospores and produce unrease or H2S

front 57

Shigella is known to cause _____ ______.

back 57

Shigella dysenteriae

front 58

What is dysentery?

back 58

Diarrhea containing blood

front 59

What are symptoms of Shigella?

back 59

  • Frequent, watery stools, fever, and intense abdominal pain
  • Nausea and vomiting are common
  • Dysentery
  • Mucus from GI tract will also be present in stools

front 60

_____ __________ causes the most severe form, is uncommon in the United States, and occurs primarily in the Eastern Hemisphere.

back 60

Shigella dysenteriae

front 61

Shigella are primarily human _____. All produce a similar disease, including ____ ____, that can vary.

back 61

Parasite; Bloody Diarrhea

front 62

Where is Shigella dysenteriae most common?

back 62

This most severe form is primarily common in the Eastern Hemisphere. It is uncommon in the United States.

front 63

How is Shigellosis different from other GI tract infections?

back 63

  • Shigella invades the villus cells of the large intestine rather than small intestine.
  • Not as invasive as Salmonella and does not perforate the intestine or invade the blood

front 64

How does Shigella enter the intestinal mucosa?

back 64

It enters the intestinal mucosa by means of lymphoid cells in Peyer's patches. Once in the mucosa, Shigella instigates an inflammatory response that causes the extensive tissue destruction.

front 65

The endotoxin released by Shigella causes ____

back 65

Fever

front 66

The enterotoxin released by Shigella...

back 66

Affects the entire GI tract, damages the mucosa and villi, and gives rise to bleeding and secretion of mucus

front 67

The shiga toxin released by Shigella...

back 67

is responsible for more serious damage to the intestine as well as systemic effects; it interrupts protein synthesis in its target cells

front 68

Shigella is localized or systemic?

back 68

Localized to the intestines

front 69

Shiga-Toxin-Producing Escherichia coli (STEC)

back 69

  • Another shiga toxin producer
  • Some common signs and symptoms are those GI problems, and very rarely, sometimes you can see hemolytic uremic syndrome
  • Toxins are identical to shiga toxins produced by Shigella

front 70

How is STEC transmitted?

back 70

Ingestion of undercooked beef and other contaminated foods and beverages

front 71

What is the hemolytic uremic syndrome?

back 71

Severe hemolytic anemia that can cause kidney damage and failure

front 72

Most common bacterial cause of diarrhea in the United States is _________

back 72

Campylobacter

front 73

What are some signs and symptoms of Campylobacter?

back 73

  • Frequent watery stools, fever, vomiting, headaches, and severe abdominal pain
  • Symptoms may last longer than 2 weeks and recur

front 74

Campylobacter jejuni is a Campylobacter species. What is the morphology?

back 74

Curved or Spiral Gram-Negative with polar flagella

front 75

Where are Campylobacter jejuni found?

back 75

These tend to be microaerophilic inhabitants of the intestinal tract, genitourinary tract, and oral cavity of humans and animals

front 76

How is Campylobacter transmitted?

back 76

Ingestion of contaminated beverages, food, water, milk, meat, and chicken

front 77

In a small number of cases of Campylobacter, infection can lead to a serious neuromuscular paralysis called ______________________

back 77

Guillain-Barre syndrome

front 78

What is the Guillain-Barre syndrome?

back 78

  • Leading cause of acute paralysis in the US (good news is that many patients recover completely)

front 79

What is the prevention and treatment of Campylobacter?

back 79

  • Rehydration and electrolyte-balance therapy
  • Azithromycin in severely affected patients
  • Prevention depends on rigid sanitary control of water and milk supplies and care in food preparation

front 80

Clostridioides difficile is a gram-________ bacteria and the morphology is ________.

back 80

Clostridioides difficile is a gram-positive, endospore-forming rod

front 81

True or False: Clostridioides difficile was once considered part of our normal biota (harmless).

back 81

True; It was once considered relatively harmless but now is known to cause a condition called pseudomembranous colitis, also known as antibiotic-associated colitis.

front 82

How is pseudomembranous colitis caused?

back 82

Pseudomembranous colitis is known as a antibiotic-associated colitis because in many cases, this infection is precipitated by therapy with broad-spectrum antibiotics. --> Major cause of diarrhea

front 83

Clostridioides difficile is able to superinfect the large intestine when drugs have distrupted the normal biota. It results in the production of two enterotoxins (A and B) which essentially results in...

back 83

necrosis in the wall of the intestine --> in more severe cases the colon is inflamed and gradually sloughs off loose, membranelike patches called pseudomembranes consisting of fibrin and cells --> if not stopped, perforation of the cecum and death can result

front 84

What is the predominant symptom of Clostridioides difficile?

back 84

Diarrhea (in some severe cases, it can cause abdominal cramps, fever, and leukocytosis)

front 85

What are some treatments of Clostridioides difficile?

back 85

  • Withdrawal of antibiotics, replacement of fluids
  • Fidaxomicin or vancomycin
  • Fecal transplant

front 86

What is the morphology of vibrio cholerae?

back 86

Curved rod with a single polar flagellum

front 87

What are some characteristics of vibrio cholerae?

back 87

  • Fermentative
  • Grow on ordinary or selective media containing bile at 37 degrees Celsius
  • Possess unique O and H antigens and other membrane receptor antigens

front 88

When are spikes of cholera seen?

back 88

Outbreaks of cholera are expected to happen after natural disasters, war, or large refugee movements

front 89

What are two types of cholera?

back 89

Class and El Tor

front 90

Signs and symptoms of Vibrio cholerae include:

back 90

  • Vomiting
  • Copious watery feces, "rice-water stool"
  • Profuse water loss (so you get really dehydrated and that gives you hypotension --> get tachycardia --> go into shock)
  • Loss of blood volume, acidosis, potassium depletion, muscle cramps, severe thirst, flaccid skin, and sunken eyes; convulsions and coma in young children
  • Hypotension, tachycardia, cyanosis, shock
  • 55% to 70% mortality rate

front 91

What is the toxin produced by Vibrio cholerae and what role does the toxin play?

back 91

Produces cholera toxin which disrupts the normal physiology of intestinal cells, causing them to shed large amounts of electrolytes into the intestine

front 92

What are some pathogenesis and virulence factors of Vibrio cholerae?

back 92

  • Cholera toxin
  • Uses quorum sensing to regulate the expression of virulence factors

front 93

What type of environment promotes growth of Vibrio?

back 93

Warm, monsoon, alkaline, and saline conditions

front 94

Treatment of Vibrio cholerae?

back 94

Oral Rehydration Therapy

front 95

Who found the use of sari's to help filter out water?

back 95

Rita Cowell helped reduce the amount of cholera in endemic areas, where she helped understand cholera could be found in dormant water and the water can be filtered using sari's.

front 96

Non-cholera vibrios lack the _____.

back 96

Cholera toxin

front 97

True or False: It is more common to experience an infection with a non-cholera species of Vibrio than a V. cholerae infection.

back 97

True; These infections are called vibrioses.

front 98

What are the prominent causative agents of Non-Cholera Vibrio (aka vibriosis)?

back 98

V. vulnificus and V. parahaemolyticus

front 99

What three factors increase the chance of vibrioses?

back 99

  • Increased consumption of raw oysters
  • Increased awareness; more people are diagnosed
  • A warming climate increases the microbe's habitats

front 100

Cryptosporidium is a type of _________.

back 100

Protozoa

front 101

Describe crytosporidium

back 101

  • The oocyst form is resilient and can immediately infect
  • Once inside the intestines, the oocytes releases sporozytes that attach to the epithelium of small intestines where it will live inside. It will eventually make more of these protozoa that are released into the gut and release through the stool to infect others
  • The symptoms are similar to other gastroenteritis, and these are very resistant to chlorine and other disinfectants
  • Symptoms include headache, sweating, vomiting, severe abdominal cramps, and diarrhea

front 102

Crytosporidium outbreaks occur in ______.

back 102

Swimming pools

front 103

What are Rotaviruses?

back 103

  • Double-stranded RNA with an inner and outer capsid
  • Primary cause of morbidity and mortality resulting from diarrhea

front 104

How is Rotavirus transmitted?

back 104

Fecal-Oral Route, including contaminated food, water, and fomites

front 105

How is Rotavirus treated?

back 105

  • Via oral replacement therapy
  • RotaTeq and Rotarix are live attenuated vaccines

front 106

What is the most common food-borne virus in the United States? Why?

back 106

Norovirus; It has a low infectious dose (1 to 20 viruses)

front 107

What are symptoms of norovirus?

back 107

Profuse, watery diarrhea for 3 to 5 days, vomiting in the early stages, mild fever

front 108

How is norovirus transmitted?

back 108

  • Fecal-Oral transmission or via contamination of food and water
  • Many outbreaks associated with cruise ships

front 109

What is food poisioning?

back 109

  • Food poisoning is nausea and vomiting accompanied by diarrhea, often companions that shared a meal suffer the same fate
  • Symptoms are caused by exotoxin (therefore, sometimes thought of as an intoxication rather than infection)
  • Occasionally comes from nonmicrobial sources such as fish, shellfish, or mushrooms
  • This is acute diarrhea with vomiting caused by exotoxins

front 110

What are the three exotoxins that cause food poisoning?

back 110

  • Staphylococcus aeureus exotoxin
  • Bacillus cereus exotoxin
  • Clostridium perfringens exotoxin

front 111

This exotoxin that causes food poison is associated with custards, sauces, cream pastries, processed meats, chicken salad, or ham

back 111

Staphylococcus aureus

front 112

Staphylococcus aureus exotoxin characteristics:

back 112

  • Thrives due to high salt tolerance
  • Enterotoxin is heat stable and induces symptoms of cramping, nausea, vomiting, and diarrhea
  • Onset within 1-6 hr, recovery within 24 hours
  • Self-limiting, antibiotics are warranted

front 113

Bacillus cereus exotoxin is gram-________ bacterium that lives in the _____.

back 113

Bacillus cereus exotoxin is gram-positive bacterium that lives in the soil.

front 114

Two forms of bacillus cereus exotoxin are:

back 114

  • Emetic (vomiting) from frequently tied to fried rice that has been cooked and kept warm for long periods of time
  • Diarrheal form associated with cooked meats or vegetables held at a warm temperature for long periods of time (profuse, watery diarrhea that lasts about 24 hours)

front 115

Clostridium perfringens exotoxin is also the causative agent of __________.

back 115

Clostridium perfringens exotoxin is also the causative agent of gas gangrene.

front 116

Describe Clostridium perfringens exotoxin

back 116

  • Contaminates meat, fish, and beans that have not been cooked thoroughly enough to destroy endospores
  • Endospores germinate in foods, C. perfringens cells enter the small intestine and release exotoxin
  • Abdominal pain, diarrhea, and nausea in 8 to 16 hr
  • Also causes enterocolitis similar to that caused by C. difficile

front 117

What defines chronic diarrhea?

back 117

  • Diarrhea that lasts longer than 14 days
  • Can have an infectious or noninfectious cause; Irritable bowel syndrome (can be caused by microbiota or genetic), ulcerative colitis
  • Microbes in this section cause chronic diarrhea in otherwise healthy people

front 118

Enteroaggregative E. Coli (EAEC)

back 118

  • Associated with chronic disease, particularly in children
  • Adheres to human cells in aggregates rather than single cells
  • Stimulates large amounts of mucus in the gut
  • Transmission through food and water

front 119

Cyclospora cayetanensis

back 119

  • Emerging protozoan pathogen; numerous outbreaks in United States and Canada
  • Fecal-oral transmission from fresh produce and water
  • Oocytes can be visualized when feces is exposed to UV light
  • Only infectious when sporulated oocyst are ingested
  • Symptoms: watery diarrhea, stomach cramps, bloating, fever, and muscle aches

front 120

Giardia duodenalis is commonly known as:

back 120

  • Giardia intestinalis
  • Giardia lamblia

front 121

Giardia duodenalis is a __________.

back 121

Protozoa

front 122

Describe the morphology of Giardia duodenalis

back 122

  • Symmetrical heart shape with organelles positioned in such a way that it resembles a face with four pairs of flagella emerging from the ventral surface

front 123

Signs and symptoms of Giardia duodenalis:

back 123

  • Diarrhea of long duration
  • Abdominal pain
  • Flatulence
  • Greasy and malodorous stools

front 124

In Giardia duodenalis, the presence of this protozoa leads to malabsorption of _____ in the digestive tract.

back 124

In Giardia duodenalis, the presence of this protozoa leads to malabsorption of fat in the digestive tract. Usually results in significant weight loss

front 125

True or False: Giardia duodenalis; Superficial invasion by trophozoites causes damage to the epithelial cells, edema, and infiltration by white bloods, which is irreversible.

back 125

True

front 126

Where is Giardia isolated from?

back 126

  • Beavres
  • Cattles
  • Coyotes
  • Cats
  • Human Carriers

front 127

Although trophozoites and cysts escape in the stool, _____ play a greater role in transmission. Why?

back 127

Although trophozoites and cysts escape in the stool, cysts play a greater role in transmission. Giardia cysts can survive for 2 months in environment and are usually ingested with water and food or swallowed after close contact with infected people or contaminated objects.

front 128

True or False: Giardiasis can easily be diagnosed from feces.

back 128

False; Giardiasis can be difficult to diagnose because the organism is shed in feces only intermittently.

front 129

Where do outbreaks of Giardia occur?

back 129

Epidemics can be traced to water from mountain streams as well as chlorinated municipal water.

front 130

True or False: The treatment for Giardia is a vaccine.

back 130

False; No human vaccine is available. Avoiding drinking from freshwater sources is the major preventive measure. The agent is killed by boiling, ozone, and iodine; however, the amount of chlorine used in municipal water supplies does not destroy the cysts.

front 131

Entamoeba is a _________.

back 131

Entamoeba is an amoeba that are widely distributed in aqueous habitats.

front 132

The Entamoeba histolytica has a relatively simple life cycle that alternates between ________ that is motile by means of __________ and a _____, ______, nonmotile _______.

back 132

The Entamoeba histolytica has a relatively simple life cycle that alternates between trophozoite that is motile by means of pseudopods and a smaller, compact, nonmotile cyst.

  • Trophozoite lacks most of organelles and has a single nucleolus called karyosome.
  • The mature cyst is encased in a thin yet tough wall and contains four nuclei as well as chromatoidal bodies, which are actually dense clusters of ribosomes.

front 133

Entamoeba hysolytica

back 133

  • Secrete enzymes that dissolve tissues
  • Exist in intestinal and extraintestinal forms
  • Humans are primary hosts; infection through food and water contaminated with cysts

front 134

Intestinal Amoebiasis

back 134

  • Initial targets are cecum, appendix, colon, and rectum
  • Actively penetrates deeper layers of mucosa leaving ulcers
  • Dysentery along with abdominal pain, diarrhea, fever, and weight loss
  • Can lead to hemorrhage, perforation, appendicitis, and amoebomas
  • Goes to intestine

front 135

Extraintestinal Amoebiasis

back 135

  • Amoeba invade the viscera of the peritoneal cavity invading the liver
  • Goes to the liver

front 136

In general, what is hepatitis?

back 136

Hepatitis is the inflammatory disease of the liver:

  • Necrosis of hepatocytes
  • Response by mononuclear white blood cells that swells and disrupts the liver architecture
  • Interferes with excretion of bile pigments and causes bilirubin to accumulate in blood and tissues, causing jaundice (yellowing of the skin and eyes)

front 137

Hepatitis A

back 137

  • Non-enveloped, single-stranded RNA enterovirus
  • Signs and symptoms include subclinical or vague flu-like symptoms, fever, nausea, abdominal pain, dark urine -- may have jaundice (in only about 10% of the cases)
  • Transmitted via fecal-oral, associated with deficient personal hygiene and lack of public health measures
  • Vaccine is available, but if contracted, bed rest and plenty of fluid are key for management
  • There is no cure

front 138

Hepatitis B

back 138

  • Enveloped DNA virus (able to integrate)
  • Signs and Symptoms: Fever, chills, malaise (usually asymptomatic), abdominal discomfort, diarrhea, and nausea; rashes and arthritis may occur; cause of hepatocellular carcinoma
  • Transmitted by minute amounts of blood (sexual, parental, and vertical)
  • Vaccine is available, but there is no cure
  • Vaccine is important for health care workers and students, patients receiving multiple transfusions, immunodeficient persons, and cancer patients
  • No cure
  • 4-6 weeks to see positive test

front 139

Hepatitis C

back 139

  • Enveloped RNA virus
  • Silent epidemic: 3.5 million Americans infected
  • Transmission via blood transfusions and needle sharing
  • Signs and symptoms include fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, and juandice
  • About 2 weeks for a positive test and symptoms
  • No Vaccine
  • Two drug regimen: Sofosbuvir (a nucleotide analog that “fools” the RNA polymerase of the virus) and simeprevir (a protease inhibitor)

front 140

______________ is a hallmark of helminthic infection.

back 140

Eosinophilia is a hallmark of helminthic infection

front 141

What are some general clinical considerations (pathogenesis and virulence factors) of helminth infections?

back 141

  • Specialized mouthparts for attachment and feeding, enzymes to liquefy and penetrate tissues, and cuticle for protection from host defenses
  • Definitive host: Host in which the adult worm reproduces sexually

front 142

Diagnosis of helminth diseases include:

back 142

  • Eosinophilia
  • Discovery of eggs, larvae, or adult worms in stool or tissues

front 143

What are some prevention and treatment of helminth diseases?

back 143

  • No vaccines available
  • Regular treatment with antihelminthic drugs
  • Proper sewage disposal
  • Avoiding using human feces as fertilizer
  • Disinfection of water supply
  • Thoroughly washing and cooking vegetables and meats
  • Freezing foods

front 144

Describe cycles A and B of basic helminth life and transmission.

back 144

front 145

Describe cycles C and D of basic helminth life and transmission.

back 145

front 146

The most common worm disease of children in temperate zones is _______________.

back 146

Enterobius vermicularis

front 147

Enterobius vermicularis is a _______ disease.

back 147

Pinworm

front 148

Enterobius vermicularis is a life cycle ___ type.

back 148

Enterobius vermicularis is a life cycle A type.

front 149

The hallmark of Enterobius vermicularis is ____________.

back 149

The hallmark of Enterobius vermicularis is anal itching

front 150

Is the Enterobius vermicularis fatal?

back 150

The infection is not fatal and most cases are asymptomatic. When one member of the family is diagnosed, the entire family should be tested and/or treated because it is likely that multiple members are infected.

front 151

Trichuris trichuria is ________ and is life cycle ________.

back 151

Trichuris trichuria is whipworm and is life cycle A.

front 152

In the Trichuris trichuria, _____ are the sole host.

back 152

In the Trichuris trichuria, humans are the sole host.

front 153

Where is the highest incidence of Trichuris trichuria?

back 153

In the tropics and subtropics that have poor sanitation

front 154

In Trichuris trichuria, females lay _______ to ______ eggs daily in the bowel.

back 154

3,000 to 5,000

front 155

What are symptoms of Trichuris trichuria?

back 155

  • Localized hemorrhage of the bowel
  • Dysentery
  • Loss of muscle tone
  • Rectal prolapse (can be fatal in children)

front 156

Diphyllobothrium latum is a _______ disease in which _____ are definitive host and ____ are intermediate host.

back 156

Diphyllobothrium latum is a tapeworm disease in which humans are definitive host and fish are intermediate host.

  • Can be transmitted via sushi and sashimi
  • Also transmitted in the Great Lakes, Alaska, and Canada
  • Symptoms include abdominal discomfort or nausea, anemia

front 157

Hymenolepsis species includes ____ ______ and its life cycle is _____. There are two species _______ ____ and ______ ______.

back 157

Hymenolepsis species includes small tapeworms and its life cycle is C. There are two species Hymenolepis nana and Hymenolepsis diminuta.

  • Hymenolepsis nana - Dwarf tapeworm
  • Hymenolepsis diminuta - Rat tapeworm

front 158

Taenia solium causes ___________

back 158

Cysticerosis

front 159

Taenia solium is a ______.

back 159

Tapeworm

front 160

Cysticercosis occurs when...

back 160

Cysticercosis occurs when humans ingest tapeworm eggs rather than infected meat

front 161

What is the life cycle of Taenia solium?

back 161

Life Cycle C

front 162

Where is Taenia solium distributed?

back 162

Distributed worldwide, but concentrated in areas where humans live in close proximity with pigs or eat undercooked pork

front 163

Fasciola heptica is a ____ ____ common in sheep, cattle, goats, and other mammals.

back 163

Liver fluke

front 164

Symptoms of Fasciola hepatica

back 164

vomiting, diarrhea, hepatomegaly, and bile obstruction if infected with a large number of flukes

front 165

Who is the definitive host of Fasciola hepatica?

back 165

Mammals

front 166

Liver and intestinal disease is caused by...

back 166

Fasciola hepatica

front 167

Schistosomiasis is a _______ disease

back 167

Liver

front 168

The causative organism of Schistosomiasis is...

back 168

Schistosoma masoni and S. japonicum

front 169

Schistosoma masoni and S. japonicum similarities:

back 169

  • Morphologically and geographically distinct
  • Similar life cycles, transmission methods, and disease manifestations
  • Can invade intact skin

front 170

Signs and Symptoms of Schistomiasis

back 170

  • Itchiness in the area where the worm enters the body, fever, chills, diarrhea, and cough
  • Chronic infection: hepatomegaly, liver disease, splenomegaly
  • Bladder obstruction, and blood in the urine
  • Can cause a granulomatous response in the nervous system and heart

front 171

Pathogenesis, Diagnosis of Schistosomiasis

back 171

  • Pathogenesis and virulence factors:
  • Parasite coats its outer surface with proteins from the bloodstream, cloaking itself from the host defense system
  • Diagnosed through identifying eggs in urine or feces
  • Cycle of infection cannot be broken as long as people are exposed to untreated sewage
  • Praziquantel is the drug of choice

front 172

Life Cycle of Schistosoma is ___

back 172

D

front 173

Streptococcus mutans

back 173

  • Gram-Positive
  • Causes Dental Caries

front 174

Helicobacter pylori

back 174

  • Gram-Negative
  • Causes Gastritis/Gastric Ulcers

front 175

Clostridium perfringen

back 175

  • Gram-Positive, Endospore-Forming Bacteria
  • Causes antibiotic-associated diarrhea

front 176

Hepatitis A

back 176

  • RNA Virus
  • Causes "Infectious" Hepatitis

front 177

Hepatitis B

back 177

  • DNA Virus
  • Causes "Serum" Hepatitis

front 178

Hepatitis C

back 178

  • RNA Virus
  • Causes "Serum" Hepatitis

front 179

Schistosomas

back 179

  • Helminths - Trematodes
  • Causes Schistosomiasis

front 180

Rotavirus

back 180

  • RNA Virus
  • Causes Acute Diarrhea

front 181

Mumps virus

back 181

  • RNA Virus
  • Causes Mumps

front 182

Giardia duodenalis

back 182

  • Protozoa
  • Causes Chronic Diarrhea

front 183

Enterobius vermicularis

back 183

  • Helminths - Nematodes
  • Causes intestinal distress

front 184

Taenia solium

back 184

  • Helminths - Cestodes
  • Causes Cysticerosis ( Formation of sacs of fluid (cysts) to form in your body)
  • Pork tapeworm

front 185

Fasciola hepatica

back 185

  • Helminths - Trematodes
  • Causes liver and intestinal disease

front 186

Salmonella

back 186

  • Gram-Negative
  • Causes Acute Diarrhea

front 187

Shigella

back 187

  • Gram-Negative
  • Causes Acute Diarrhea and Dysentery

front 188

Shiga toxin-producing E. Coli

back 188

  • Gram-Negative
  • Causes Acute Diarrhea plus Hemolytic Syndrome

front 189

Other E. coli

back 189

  • Gram-Negative
  • Causes Acute or Chronic Diarrhea

front 190

Campylobacter

back 190

  • Gram-Negative
  • Causes Acute Diarrhea

front 191

Clostridioides difficile

back 191

  • Gram-Positive, Endospore-Forming Bacteria
  • Causes antibiotic-associated diarrhea

front 192

Vibrio cholerae

back 192

  • Gram-Negative
  • Causes cholera

front 193

Non-cholera Vibrio species

back 193

  • Gram-Negative
  • Causes Vibrioses

front 194

Cryptosporidium

back 194

  • Protozoa
  • Causes Acute Diarrhea

front 195

Rotavirus

back 195

  • RNA Virus
  • Causes Acute Diarrhea

front 196

Norovirus

back 196

  • RNA Virus
  • Causes Acute Diarrhea

front 197

Staphylcoccus aureus

back 197

  • Gram-Positive
  • Causes Food Poisoning

front 198

Bacillus cereus exotoxin

back 198

  • Gram-Positive, Endospore-Forming Bacteria
  • Causes Food Poisoning

front 199

Clostridium perfringens exotoxin

back 199

  • Gram-Positive, Endospore-Forming Bacteria
  • Causes Food Poisoning