• Because stools have numerous microbial flora, efficient screening methods must be used to recover any pathogens • Enteric pathogens include Salmonella, Shigella, Aeromonas, Campylobacter, Yersinia, Vibrio, and E. coli 0157:H7 Screening Stools for Pathogens (cont’d) • Most labs screen for Salmonella, Shigella, and Campylobacter; many screen for E. coli 0157:H7 • Fecal pathogens are generally lactose-negative (although Proteus, Providencia, Serratia, Citrobacter and Pseudomonas are also lactose-negative) Staphylococcal Food Toxin • S/S: Vomiting, severe cramping, low grade fever, diarrhea (no blood in stool) • Incubation: VERY short – 30 minutes to a few hours. • Complications: None, spontaneous recovery • Diagnosis: No specific test available. Clinical dx. Staphylococcal Food Toxin • Treatment: Supportive – rest, hydration, compazine or other antiemetic for persistent vomiting • Origin: Toxin producing S. aureus strains, usually from human skin, inoculate food, multiply at room temp. Toxins not destroyed by reheating. • Other toxin producing bacteria: Clostridium perfringens, Bacillus cereus. Staphylococcal Food Toxin • Prevention – Decrease food handling – Do not allow foods to sit at room temp. for long periods – Glove use by food handlers – Exclude persons from food handling when obvious skin infections are present. Vibrio cholera
• Gram negative bacteria,
• comma shaped, arrow shaped • Highly motile, • facultative anaerobic, • curved rods with one or more flagella • Non-invasive, remains in intestinal tract V. cholera Pathogenesis • Heat labile enterotoxin (MW) of 84,000 consisting A and B. • Enterotoxin increased cAMP hypersecretion of water and electrolytes increased sodium dependent chloride secretion absorption of sodium and chloride by the microvilli is inhibited • Electrolyte rich diarrhea (20 – 30 L/day) • Dehydration, shock, acidosis, and death • Rice stool diarrhea Treatment
Antibiotics = not necessary, but would hasten organism clearance.
Macrolides (erythromycin) and azithromycin, tetracylcine or doxycycline. Summary of bacterial gastroenteritis Viral Gastroenteritis • Most common cause of infectious diarrhea in US • Infect epithelium of small intestine • Diarrhea is watery • WBC’s and visible blood are rare • 4 categories: Rotavirus, Claicivirus (norovirus), Astroviurs, Enteric Adenovirus. Rotavirus • Most common cause of diarrhea in young children • Highly contagious: fecal-oral. • Incubation 1-3 days, lasts 4-8 days • Dehydration and hospitalization common in young children • Diagnose by EIA antigen in stool • Treat with oral rehydration or IV • Oral vaccine now available (controversial) Calcivirus • Infect older children and adults • Nonspecific, self-limiting • Large water-borne and food-borne outbreaks occur, fecal-oral • Incubation 24-48 hrs, lasts 12-60 hrs • No commercial tests to diagnose • Treatment supportive (oral rehydration) Viral causes Gastroenteritis virus vs bacterial
Utilization of The Microbiology Laboratory For Diagnosis of Infectious Diseases 2018 Update by The Infectious Diseases Society of America and The American Society For Microbiology