Cpd Nonviral GI

8/13/2019 Cpd Nonviral GI

1/21


2/21

Enterobacteriarod shaped, gram negative.

Discovered by Theobald Smith w/ Daniel Salmon

Many serotypes, main ones of interest: s. enteritidis, s.

typhi, s. paratyphi Symptoms : Diarrhoea, vomiting, fever ~1/52

(typhoid/paratyphoidepistaxis, fever, bradycardia,

delirium, other complications)

Mode of transmission: Mainly via foodstuffinsufficiently cooked food or contamination of cooked

food. Person to person spreadfaeco-oral route.

Contact with infected animals

Incubation period : 12-72 hours


3/21

Diagnosis made via blood or stool culture. Treatment generally supportiverehydration, with

antibiotics (amoxicillin, ciprofloxacin).

Complicationsmost commonly reactive arthritis. With

typhoid/paratyphoid

encephalitis, intestinalhaemorrhage/perforation, abcesses, disseminated

infection.

Mortality rate:

Typhoid fevertreated: 1-4%

Typhoid feveruntreated 10-30%

Salmonellosis -


4/21

Salmonella by serotype (2010)

Most common serotype s. enteritidis

Salmonella by Serotype

0

500

1000

1500

2000

2500

3000

3500

4000

4500

S.enteritidis

S. typhimurium

Typhoidal salmonellas

Other salmonellas


5/21

Salmonella rates by age (2010)

Most common in children


6/21

Salmonella cases reported by region (2009)

All serotypes included

Salmonella by reporting region

0

200

400

600800

1000

1200

1400

1600

1800

2000

East Midlands

East

London

Northeast

Northwest

Southeast

SouthwestWest Midlands

Wales

York & Hum


7/21

Rod shaped, gram negative. Closelyassoc. e. coli. Discovered 1898 - K.Shiga

Main serogroups of interest: shigellasonnei, s. flexneri, s.boydii,s.dysenteriae

Symptoms : Watery diarrhoeafollowed by bloody diarrhoea

Mode of transmission: Mainly faeco-oral contamination route as well asfoodstuff/water. Houseflies.

Incubation period : 1-7 days


8/21

Diagnosis made via stool culture.

Treatment generally supportiverehydration, with

antibiotics (amoxicillin, ciprofloxacin).

Complicationsmost commonly reactive arthritis.

Rarely seizures in children. WHO estimate: 90 million episodes worldwide with 108

000 deaths annually.

Vaccine currently under development, mainly for s.

flexneri and s. sonnei.


9/21

Shigella by serogroupreported faecal isolates (2010)

1123

496

85

42 Shigella by serogroup

S. sonnei

S. flexneri

S. boydii

S. dysenteriae


10/21

Rod-shaped bacteria, gram negative. Harmless strains of e.coliusually part of normal gut flora. Discovered 1885 by TheodorEscherich.

Pathogenic strains of e.colicommonly O157, O104, O121, O26,O45, O145.

Classified by virulence propertiesETEC, EPEC, VTEC.

Symptoms : Diarrhoea/bloody diarrhoea. Most common pathogenfor UTIs. Serotype with K1 antigen causes neonatal meningitis.

Mode of transmission: Faecal-oral routeusually ingestion ofimproperly cooked or contaminated food.

Incubation period : 1-10 days


11/21

Diagnosis made via culture/microscopy.

Treatmentantibiotics depending on strain and

resistance.

ComplicationsVTEC most commonly assoc.

haemolytic uraemic syndrome and thromboticthrombocytopaenic purpuraapprox 10% develop

HUS.

ETECmost common cause of travellers diarrhoea

approx 200 million diarrhoea episodes and 170,000deaths annually.

VTECmortality rate in cases associated with HUS : 2-

10%

ETEC vaccines available for at-risk travellers


12/21

E.coli O157 cases by region (2011)

5687

74

92

193

151

163

83

91

0 50 100 150 200 250

Regional totals

Wales

West MidlandsSouthwest

Southeast

Northwest

Northeast

London

East England

East Midlands


13/21

Corkscrew, gram negative.

Campylobacter sp. - mainly c. jejuni and c.coli

Symptoms : Diarrhoea, myalgia

Mode of transmission: Ingestion of contaminated orundercooked foodstuff (esp. poultry). Faeco-oral route

person to person or contact with infected animals

Incubation period : 2-5 days usually


14/21

Diagnosis made via stool culture. Treatment generally supportiverehydration, with

antibiotics (erythromycin).

Complicationsc. jejuni assoc. haemolytic uraemic

syndrome & thrombotic thrombocytopaenic purpura.Also causes autoimmune-associated demyelination

polyneuropathy of lower limbs, i.e. Guillian-Barre

syndrome.

WHO estimated 400 million cases worldwide annually. No vaccine currently availableimmunity appears to be

complex and strain-specific.


15/21

Campylobacter by age group (2011)

43631695

1500

2385519949

7717

5416

Campylobacter by age group

0-4

5-9 years

10-14 years

15-44

45-6465-74

75+


16/21

Campylobacter by region (2011)

Campylobacter by region

0

2000

4000

6000

8000

10000

12000

East England

East Midlands

London

North East

North West

South East

South West

West Midlands

Wales

Yorkshire & Humberside


17/21

Cryptosporidiumprotozoan parasite insmall intestine

Sp. of notec. parvum and c.hominis

Symptoms : Diarrhoea (may be chronic in

immunocompromised)

Mode of transmission: Contact withinfected animals. May be transmittedthrough food/water (inc. swimming pools).Person to person spread.

Incubation period : Average 7-10 dayshowever can reach 28 days.


18/21

Diagnosis made via stool microscopy or PCR Treatment generally supportiverehydration

Complicationsrarely pancreatitis. May cause chronic

and severe diarrhoea in immunocompromised :

malabsorption and dehydration. No vaccine currently availablestill in development


19/21

Cryptosporidium by month (2011)

0

50

100

150

200

250

300

350

400

Lab reports

Lab reports


20/21

Flagellated protozoan parasitegiardia lamblia

Symptoms : Diarrhoea, abdominal cramps

Mode of transmission: Person to person contact, faeco-

oral. Ingestion of contaminated water/food Incubation period : 5-25 days


21/21

Diagnosis made via stool microscopy/ELISA.

Treatment generally supportive and self-resolves

rehydration, with antibiotics if required (metronidazole).

Complicationsdamage to the intestinal epithelial cells

lactose intolerance/B12 malabsorption

279354

533

42

543

763

608

219154

309

0

100

200

300

400

500

600

700

800

900

Giardia cases by region

East Midlands

East

London

Northeast

Northwest

Southeast

Southwest

West Midlands

Wales

Yorkshire and Humberside

Cpd Nonviral GI

Documents

Transcript of Cpd Nonviral GI