Fever, diarrhea, abdominal cramps

1
Crohns, acute ulcerative colitis, acute
appendicitis
Incubation 1-7 days
Incubation 8-48 hrs
Millions/year USA
(can progress to bloody)
30-40 Guillan-Barre, USA
Reiters syndrome
Nausea, vomiting, 50 have fever Abdominal
cramps, diarrhea 2-4 d, Diarrhea, no pus. Self
limiting 5-7 d
Fever, diarrhea, abdominal cramps
(leukocytes) lasts 5-10 days
Diagnose by Stool Culture
73,000 cases/yr USA
Not much fever, diarrhea, cramps
Treatment Flush Except systemic salmonella
amp/gent
3-5 HUS( up to wks after infx)
Most common cause acute kidey failure child
2
microaerophilic
CDT
LOS
CDT
Age Peaks
C.
lt 1yr
15-44
Serum resistance from surface protein Gastroenteri
tis that may become systemic
Incubation 1-7 days
lasts 5-10 days
Penicillin Ceph STX-TMP
30-40 Guillan-Barre, USA
Fever, diarrhea, abdominal cramps
(leukocytes)
3
Salmonella enteritidis / typhimurium
Liver Gallbladder
CFTR receptor Fecal-Oral Vi antigen
Acid tolerant pH 3-4
ID 15-20
16 million cases/yr 600,000 die
incub 1-3 wks
SPI-1
Vaccine Vi polysac capsule antigen (IM) Ty21a-
live, attenuated, oral
Mcell
H antigen
Inhibits phagolyso
Peak 5-12 yrs old
SPI-2
Asymptom carriers
Incubation 8-48 hrs
Amp Gent
Reiters syndrome
Nausea, vomiting, 50 have fever Abdominal
cramps, diarrhea 2-4 d, Diarrhea, no pus. Self
limiting 5-7 d
4
LEE- intimin, contact dep secretion, TIR
DAEC
Secrete bacterial protein
into cell.. PLC, IP3-, IL-8
Loss microvilli TIR
LT ST
Dr fimbriae
CAF-4
CFA-4
CFA-1
CFA-2
CFA-2
STX-TMP
STX-TMP
Pili
Quin
Quin
Hemolytic Uremic Syndrome 1.Hemolytic anemia
2.Thrombocytopenia 3. Glomerular
Thrombosis 4.acute renal failure TX
Transfuse and hemodialysis Develops in kids
NO Antibiotics
Removes Adenine from 28S
STX
0157H7 Watery Bloody
Little fever, no pus
Gb3
STX
Day 4 Day 6
5
EAEC - Persistent Watery Diarrhea Mostly in
developing countries. VIRULENCE FACTORS Adherence
AAF pili (aggregative adherence fimbriae) and
dispersin Toxins EAST ST-like toxin Pet
Serine protease. Hemolysin
EIEC Distinctively Different Invasion of
epithelium. Similar to Shigellosis but less
severe. Children under 5 in developing countries.
Humans are sole reservoir. Virulence genes Can
lyse cell and spread laterally.
STX-TMP
Quin
6
M
a5B1
Shiga Toxin ONLY released by cell lysis. DOES
NOT kill the invaded mucosal cells. Toxin affects
vascular tissues BLOODY STOOLS. Flexneri
dysenteriae
HIGH INFECTIVITY 100 bugs
sonnei
Quinolon 3rd Ceph
ISCA
IL-8 PMN
Host dies
IL-1
IPaB
ICE
Food, fingers, feces, flies
Shiga toxin Interrupts 28S rRNA
Reiters Syndrome flexneri(3)
HLA-B27
7
CTX
VPI-1 Tcp pilli(CTX receptor)
VPI-2 Neuramindase
ZOT ACE
Polysaccharide cap Protease
Phospholipase
Broad
Cl-

RIP 50
Generally self limiting 1-2
incubation
8
aerotolerant
Corynebacterium diphtheriae
(G rod)
Clostridium botulinum
pain/heaviness
(G rod)
sym. paralysis
alpha toxin labile, spore not lecithinase-myonecr
osis
severe nausea no fever
blocks Ach release Zn protease heat
labile Incubation 12h-8d
Cranial nerve palsy Blurred vision
(60-90)
4-14 days incubation tx Abs to toxin
Clostridium difficile
Clostridium difficile
(G rod)
penicillin
(G rod)
(G rod)
colitis and diarrhea 5-10 days after start of
antibio or after discontinued
Clostridium tetani
exotoxin
Tetanospasmin- neurotox blocks glycine(inhib)
9

Fusobacterium sp (G rod) Anaerobic Meningtis
Penicillin
10
18,000 cases/yr USA
11
3rd Ceph
E. coli
E. cloacae
LPS
ST LT
meningitis
K H antigen
UTI
Penicillin Cipro
Ferment lac motile, capsule
B-lactamase
found pts tx with antibiots diabetics and
indwelling cath respiratory and UTI, burns
K-O-H
Serratia marcescens
Klebsiella pneumonia (lobar)
O
nonmotile
No capsule
Room Temp
H
O
O
H
O
DNAse
O antigen capsule
ST LT
3rd Ceph
B-lac
B-lactam
amikacin
Catheters herion user
B-lactamase
12
No
L. monocytogenes
Amp
Internalin A Listeriolysin O PI-PLC
ActA PC-PLC
BOTH
Onset time 12 h
large infectious dose 1 million
MORTALITY 50 70
Y. pseudoTB gt no diarrhea 75 5-20 yr
VERY RARE
NO ST
30-100
Granulomatosis infantiseptica
13
Enteric Fever Rare FEVER CHILLS
SHOCK
Y. enterocolitica 1-2 day incubation
ST
Yops V ag inhibit phago MQ apoptosis
cytokine (IL-8,TNF,IFN)
liver
M cells
Tetra Amino STX
Reactive arthritis (small ) HLA-B27
14
Streptococcus mutans
Actinomyces israelii (G rod)
Anaeorobic, filamentous
Propionibacterium acnes (G rod)
Clostridium difficile (G rod)
Gingival crevice female UGT
Liver Lung abscess Skin
Penicillin
Helicobacter pylori
BabA CagA
VacA
IL-8
Type II NO CagA
LPS
Type I Ulcers and Cancer
Fecal-oral and contaminated H20
15
Bacteroides fragilis (G- rod)
Proteus mirabilis, motile
B-lactam
GI brain abscess, cellulitis
Capsule Collagenase Hyaluronidase
Amp Ceph
Tetra
Metro Clind
swarming
Treponema pallidum
Perivascular infiltrate.
Penicillin
Caution JH rxn
16
ABC- Africa/Blindness and chronic infx
Doxy Erythro
Enterococcus Faecalis
D-K subtypes
Intestinal oral
L1,L2,L3
No peptidoglycan Long incubation 10-21 days
O
Tetra Erythro
O
Type III secretion inhibits phagolyso
9 hrs
ATP-ADP translocase
16-20 hrs
17
R. prowazeki
Brill-Zinsser-mild
RMSF
R. rickettsii transovarian tsmsm
Tetra
Refugee Camp- wash clothesgt50 C
Incub 2-14 day Fever day 5 Rash day 3-12
IFA/latex biopsy
OmpA
Doxy
RIP 25
RIP 40
Escape phagosome replicate in
cytoplasm actin tail filament propulsion
Rash begins on upper trunk day 5, macular. Cough,
confusion, stupor.
untreated
Ehrlichia chaffeensis
Lonestar Tick(Amblyomma americanum) Human
Monocytic Ehrlichiosis(HME) Anaplasma
phagocytophilum Ixodes spp
(Lyme, babesiosis, anaplasmosis)
Endemic Typhus( R. typhi R. felis)
50 rash by day 6, 50 no rash
Flu like- rash rare leuko/thrombopenia
ALL NEED CoA and NAD from Host
Flu like symptoms hacking
non-productive cough X-ray shows pulm
densities 10 ICU STX-TMP,age, disease increases
risk
RIP 2-5
morulae
Human Granulocytic Ehrlichiosis(HGE)
18
Early- Bells palsy, men, enceph Cardiac- AV
node block, myo/pericarditis Late- inflamm
arthritis, 1 sided, large joint
90 anicteric, flu like, men, 1-3 wks resolves
10 Weils syndrome high fatality
VlsE-surface, recombine
Incubation 7-14 days(can be 3-30)
SPFL
little/no spread via blood ass. with
collagenous tissue persistent infxn
LPS enter skin or
mucus membrane
B-lac/Tetra
oral
B-lac/tetra 3-4 wks
IV
(hydrocorticoid acetaminophen)
Borrelia recurrentis
Borrelia hermsii Endemic Tick-Borne
Relapsing Fever Ornithodoros spp soft
tick VMP(variable membrane protein)-
recombination 40 C spikes Incubation
1.5 wks
B-lac tetra
Relapsing Fever
Caution J-H Rxn
3 um
Louse crush juice Ethiopia Fever,
malaise. Similar to TBRF, but gt fatality
Giemsa stained blood
19
Coxiella burnetii (G- coccobacillus)
½ symptomatic High fever(104) 1-2 weeks
Obligate intracell, cytoplasm rep Spores Dust,
meat, tick, soil Flu like, cough, pneumo
hepatitis IFA, ELISA
Q fever
RIP 1-2
No rash
Doxy
Atypical pneumo ARDS DIC lymphadenopathy
Perivasculitis
PLAGUE
RIP 0-30
Tetra
Day 3 Day 7 Day 10
Orietia tsutsugamushi
LcrV and Yops
Mouth intestine