CAMPYLOBACTER & HelicobacterCAMPYLOBACTER & Helicobacter

• Gram negative curved rodsGram negative curved rods

Dr. H.Gh.Safaei

To be familiar with Camylobacter & Helicobacter species

To describe the characteristic of those To understand the pathogenesis of

those To explain the diseases , Clinical

finding, diagnosis , treatment and prevention

Dr. H.Gh.Safaei

Cause enteritis Occasionally systemic infection

C. jejuni & C. coli infections indistinguishable

2 million case / year in USA

Dr. H.Gh.Safaei

• Gram negative Gram negative • Curved or spiral , comma, S , gull wing Curved or spiral , comma, S , gull wing • Motile single polar flagellum Motile single polar flagellum • Thermophile Thermophile

Dr. H.Gh.Safaei

1. Temperatures > 55 deg. C destroy

2. Sensitive to desiccation3. Salt, ascorbic acid4. Disinfectants, chlorinated water5. UV radiation

Dr. H.Gh.Safaei

Toxin Invasion motility, flagellar attachment, adhesion to cells, iron acquisition, inflammation actively secretion epithelial disruption serosal fluid leakage

Dr. H.Gh.Safaei

Endotoxin Cytopathic extracellular toxin

Enter toxin

Dr. H.Gh.Safaei

Oral route , food , drink , contact infected animals, sexual activity

Sensitive to gastric acid 104 organism should ingested Multiply in small intestine ----invade

epithelial ----inflammation ----white & red blood cell in stool

Occasionally blood stream is invaded Enteritis

Dr. H.Gh.Safaei

•incubation 2 to 5 days •Abdominal painAbdominal pain• DiarrheaDiarrhea• Malaise, fever, headacheMalaise, fever, headache•Usually self-limiting 5-8 days 5-8 days • Antibiotics erythromycin

SymptomsSymptomsDr. H.Gh.Safaei

DIAGNOSIS DIAGNOSIS Specimen ; stoolSpecimen ; stool Smear Smear Culture Culture Selective media Skirrow , Selective media Skirrow ,

Vancomycin, Polymyxin B, Vancomycin, Polymyxin B, Trimethoprime Trimethoprime

microaerophilic 5-10 % Co2 microaerophilic 5-10 % Co2 C. jejuni grows best 42-43 C. jejuni grows best 42-43 ooCC Oxidase , Catalase positive Oxidase , Catalase positive

Dr. H.Gh.Safaei

Sources - human – faecal-oral person-to-person - animal – cats, dogs, flies,chickenschickens, ,

cattle, cattle, sheepsheep Transmitted

milk meat productsPublic health control

Dr. H.Gh.Safaei

Dr. H.Gh.Safaei

Opportunistic pathogen Systematic infection Occasionally cause diarrhea Gastrointestinal tract entry ----bacterimia Death

Capsule like structure ( S protein )

Dr. H.Gh.Safaei

C. Lari seagull occasionally diarrhea in human

C. upsaliesis occasionally diarrhea in human

Dr. H.Gh.Safaei

TREATMENTTREATMENT• Severe diarrheaevere diarrhea

– fluid replacement essentialfluid replacement essential

• Antibiotic therapy sometimes Antibiotic therapy sometimes used in local infection but used in local infection but always in systemic diseasealways in systemic disease

Dr. H.Gh.Safaei

Gram negative Gram negative Spiral shape Spiral shape GastritisGastritis Peptic ulcer Peptic ulcer Gastric UlcerGastric Ulcer CarcinomaCarcinoma

Dr. H.Gh.Safaei

Optimal PH 6-7 Gastric mucosa impermeable to acid Lumen side PH 1-2 Epithelial side 7.4 Produce protease modifies mucus Urease activity Motile Invade to epithelial cell Toxin & endotoxin Risk factor for cancer

Dr. H.Gh.Safaei

Gasteritis Duodenal ulcer Asymptomatic

Dr. H.Gh.Safaei

Specimen Gasteric Biopsy Blood , serology Smear Culture Special tests ; Urease activity ; Rapid

Urease test In vitro Biopsy In vivo Labeled urea13 C , 14C Detect

labeled CO2

Dr. H.Gh.Safaei

1. Culture selective Media2. Skirrow ( Vancomycin , Polymyxin

B, Trimethoprim )3. 3-6 days 37°C 4. Microaerphilic5. Oxidase positive 6. Catalase Positive 7. urease NH4+ CO2

DiagnosisDiagnosisDr. H.Gh.Safaei

IgM Antibody IgG Antibody

Dr. H.Gh.Safaei

TREATMENTTREATMENT •Triple therapy Metronidazole , Bismuth, Amoxicilline , Tetracycline for 14 days • severe diarrheasevere diarrhea

– fluid replacement essentialfluid replacement essential

Dr. H.Gh.Safaei

20% of patients under 30 40-60 % age 60 80-90% developing country Person to person transmission

Intra familial

Dr. H.Gh.Safaei

H. cinaedi primary cause of bacteremia in AIDS patients

H.fennelliae Homosexual men with enteritis, &

bacteremia Rectal swab Culture Urease negative

Dr. H.Gh.Safaei

CONTROL CONTROL

1.1. Sanitary measures Sanitary measures

1.1. protect the water supply protect the water supply

2.2. Food/water borne epidemics Food/water borne epidemics

1.1. common third worldcommon third world

3.3. zoonotic infections zoonotic infections

1.1. contaminated animal contaminated animal products products

Dr. H.Gh.Safaei

Dr. H.Gh.Safaei