Pathogen Transmission Pathogenesis Symptoms Treatment/Misc

Enteropathogens
E. coli – gram neg rod
 ETEC  Fecal/oral  Secretory toxins  Travelers diarrhea
(enterotoxigenic) (enterotoxigenic)  Profuse watery
(heat stable ST, diarrhea
heat-labile LT)  No or mild
 Typical site = pain/fever
small bowel
 EPEC  Fecal/oral  Mucosal  Infantile diarrhea
(enteropathogenic) colonization and  Fever
destruction  N/V
(enteropathogeni
c)
 Small bowel
 Organisms
superficially
colonizing and
causing damage.
 EIEC  Fecal/oral  Deep invasion  Bascillary
(enteroinvasive) (enteroinvasive) dysentery
 Large bowel  Purulent bloody
dysentery
 Painful cramps
 fever
 EHEC  Fecal/oral  Zoonosis from  Hemorrhagic
(enterohemorrhagic cow intestines, or colitis
) person to person  Hemolytic uremia
 Cytotoxin syndrome
(verotoxin, Shiga-  Bloody
like toxin) diarrhea/dysenter
(enterohemorrha y
gic)  Painful cramps
 High acid  fever
 tolerance (need a
small amount of
bugs to work)
 Large bowel
Hemolytic uremia  Associated with  Cytotoxin  Thrombotic
syndrome (HUS) EHEC and produced in microangiopathy
shigella strains. intestinal lumen  Hemolytic anemia
 Children and and enters blood  Thrombocytopeni
elderly highest stream causing a with renal
risk systemic infection lesions
 Renal failure
 Bloody diarrhea
 Deaths (mostly
from EHEC)
Salmonella – gram neg rod  Fecal/oral  Non-typhoid:  Gastroenteritis  Positive blood
bacterium  Contaminated mucosal (non-typhoid): culture is likely
foods (eggs, colonization and sulfur odor of before positive
poultry) destruction (EPEC) stool, relative stool culture.
 animals  S. typhi: Systemic resistance to bile  Reservoir sites
dissemination (GI salts (gall bladder)
to blood to liver  Enteric fever (S. leading to carrier
back to GI) Typhi): systemic state.
 Small bowel signs and
symptoms.
 Diarrhea
 Fever
 N/V
Enteric fever  fecal/oral  Main cause:  Blood culture +  Colonization of
Salmonella typhi before stool gallbladder can
 Organisms enter culture lead to
through Peyer’s  Fever and continuous fecal
patches, invade abdominal pain shedding by
bloodstream more prominent asymptomatic
causing than diarrhea carrier
 bacteremia
 Replicate in liver
and return to gut
via common bile
duct
 Other causes:
salmonella
species, yersinia
enterocolitica,
campylobacter
jejuni.
Shigella – gram neg rod  Fecal/oral  Obligate human  Dysentery from
bacterium pathogen deep invasion –
 Some strains bacillary
make cytotoxin dysentery
(cell killer --> kills  Bloody
host cell) diarrhea/dysenter
 Small inoculum y
required  Painful cramps
 High acid  fever
tolerance (need a
small amount of
bugs to work).
 Large bowel
Campylobacter – gram neg  Fecal/oral  Mucosal  Occasional late  May be
rod bacterium  Contaminated colonization and dysentery from diagnosable
food (milk, destruction deep invasion microscopically in
poultry)  Deep invasive  Rare enteric fever stool
 animals (late) from systemic
 Small bowel dissemination
 Diarrhea (could
be bloody)
 N/V
 Painful
 cramps/bloody
diarrhea = late.
Vibrio cholerae – gram neg  Fecal/oral  Secretory toxin  Voluminous  Hydration,
rod bacterium  Salt water,  Constitutive watery diarrhea; electrolytes
shellfish in enterocyte cAMP “rice water  Vaccine
endemic regions production stools” (prevention)
 Massive water &  No or mild
electrolyte pain/fever.
secretion
 Low acid
tolerance (need a
TON of bugs to
work)
 Typical site =
small bowel
Vibrio parahaemolyticus –  Salt water,   Gastroenteritis
gram neg rod bacterium shellfish, sushi  Rare enteric fever
 Seen primarily
in NW and NE
Vibrio vulnificus – gram neg  Salt water,  Wound infection  Immunocomprom
rod bacterium shellfish (bullous lesion) ised at risk
 Skin abrasions  Septicemia
 NOT
gastroenteritis
Listeria monocytogenes –  Fecal/oral  Hardy and  Gastroenteritis  High risk:
gram positive rod (dairy, meat, resistant to  Can lead to: pregnant women,
bacterium cantaloupes) freezing, drying, sepsis, meningitis, neonates,
 Animals heat pneumonia, immunocomp
 Transplacental  Prolonged intrauterine
or perinatal incubation (1-3 infection
wks)
Viral gastroenteritis  Fecal/oral  Obligate  Watery diarrhea,  Prolonged
intracellular N/V recovery of
pathogens  Dehydration intestinal
 epithelial cells
(avoid dairy)
 Tx with IV fluids
 Viral shedding for
weeks after
symptoms
resolve.
 Rotavirus  Infants & young  Secretory toxin  Profuse watery  Can be dx by stool
children  Mucosal diarrhea ELISA
colonization &  Fever
destruction  N/V
 Small bowel
 Norovirus  Children &  Very contagious,
adults major cause of
outbreaks
 Adenovirus,
astrovirus
Parasite enteric infections
 Entamoeba  Fecal/oral  Ingest cysts  Amoebic  Asymptomatic
histolytica  Deep invasive dysentery: blood chronic carrier
 Replication of & pus in stool, state
trophozoites in painful cramps,  Dx by stool ELISA
intestinal mucosa fever or PCR or ova &
& wall  Disseminated parasites
 Encystation & amebiasis – microscopic exam
shedding of cysts spread and  Will eat RBC
 Trophozoite abscess formation
invasion through at distant sites
bowel wall (Rare)  Purulent bloody
 Large bowel dysentery
 Painful cramps
 fever
 Giardia lamblia
 Cryptosporidium
 hominis, C. parvum
Helicobacter pylori – gram  fecal/oral  Lifelong  Acute or chronic  Amoxicillin,
neg rod bacterium colonization of gastritis clarithromycin
stomach  Gastric and  Proton pump
 Mucosal duodenal ulcer inhibitor
secretions create  Gastric cancer  Minimize agents
microenvironmen  May be that raise gastric
t at higher pH asymptomatic pH (antacids, H2
 Bacterial urease antagonists
hydrolyzes urea to
CO2 and NH3
raising pH
Intoxication (food  Pre-formed  Stimulate T  Severe N/V
poisoning) toxin lymphocytes in and/or diarrhea
 Staphylococcus the gut
aureus  Not all strains are
(enterotoxins A, toxigenic
B, ect --> super  Small bowel
antigens)  Caused by
 Reservoir = staphylococcus
humans aureus and
 Common in bacillus cereus.
many foods with
extensive
handling during
preperation.
Respiratory Infections
Infectious Rhinitis  Aerosol droplets  Rhinoviruses (70%  Largely from host  NO antibiotics
“Common cold”  Secretion of cases) response  Treat symptoms:
contact  Respiratory  Nasal discharge hydration,
syncytial virus  Tissue edema decongestants,
(RSV)  Sneezing analgesics for
 Binds receptors  Sore throat, headache, sore
on respiratory cough throat.
 epithelial cells,  Headache  Secondary
enters, and elictis  Watery eyes complications:
inflammation.  Malaise acute otitis media
 Other types of When to reevaluate: and sinusitis
infections:  High fever, or  Exacerbation of
coronaviruses, lasting more than COPD.
respiratory 5 days  Initiation or
syncytial virus,  Rigors/shaking exacerbation of
parainfluenza chills asthma.
virus, adenovirus,  Sore throat
metapneumovirus  Cervical
,influenza virus. lymphadenopathy
(could be
developing strep
A)
 Persists more
than 10-14 days
 Severe headache
 Vomiting,
abdominal pain
 Ear pain
 Chest pain,
shortness of
breath.
 Persistent,
inconsolable
crying in baby.
Phayngitis  Aerosol droplets   Sore throat, 
“sore throat”  Respiratory erythema, edema  Diagnosis: rapid
viruses (40-80%  Fever strep test (GAS),
cases) –  Cervical throat culture
adenovirus, lymphadenopathy  Treatment:
influenza, EBV,  Exudate w/ bacterial 
HSV, measles bacteria, PMNs, penicillin (GAS),
 virus, fibrin (may nothing for viral
rhinoviruses, overlay tonsils  Rapid strep
coronaviruses, (tonsillitis) (antigen) test
RSV, (pseudomembran for GAS. (fast,
parainfluenza, e of diphtheria) specific)
enteroviruses  Petechial  Throat culture
 Streptococcus hemorrhages for strep if rapid
pyogenes (group  Ulcerations (HSV) is negative.
A strep)(15-30%  Potential  Fluids, maintain
of cases) headache, airway, pain
 Corynebacteriu abdominal pain, meds
m diphtheriae nausea.  Rest,
 Mycoplasma  Complications: antipyretics for
pneumoniae  Systemic fever, analgesics
 Chlamydophila suppurative: for pain
 Neisseria Peritonsillar  Gargling, throat
gonorrhoeae abscess, otitis lozenges.
media, sinusitis,  PCR for specific
pneumonia, bacterial or viral
impetigo, pathogens or
necrotizing panels of
fasciitis. pathogens is
 Non-suppurative available, but
sequelae of GAS: not commonly
ARF, RHD, used.
poststreptococcal
glomerulonephriti
s (PSGN), TSS.
Laryngitis  Aerosol droplets  Influenza virus  Red, swollen  Symptomatic
 Parainfluenza larynx treatment
virus  Hoarseness, loss  Usually clinically
of voice diagnosed
 Caused by voice
strain as well as
 infections
Laryngotracheobronchitis  Aerosol droplets  Usually viral  Initial cold sx  Maintain airway
“Croup”  Parainfluenza (rhinorrhea, sore  No antibiotics for
virus (75% of throat, cough) usual viral
cases)  Progresses to: etiology
 Influenza virus fever, swelling of  Cool air humidifier
 Others – measles, airway  Steroids via
adenovirus, RSV membranes nebulizer (shrinks
 Seasonal bias causing partial swollen tissue)
(mainly in winter) obstruction,  5% require
 Common in inspiratory hospitalization, 1-
children stridor, use of 3% intubation for
accessory ventilatory
respiratory assistance.
muscles  Watch for
(intercostal secondary
retractions) bacterial infection
 Seal like barking as potential
cough complication
 Nocturnal (tracheitis,
exacerbation. epiglottitis)
Acute Otitis Media  Aerosol droplets  Respiratory  Often hx of  Oral & topical
“middle ear infection”  4 outcomes: viruses preceding cold or analgesics for pain
 Asymptomatic  Streptococcus sore throat  Don’t treat the
*occurs in Eustachian nasopharyngeal pneumoniae #1  Pain in ear (not first 3 days (most
tube* colonization  Haemophilius exacerbated by likely virus) – if >3
Connection between (normal influenza #2 otoscopic exam), days: amoxicillin
nasopharynx and middle microbiota)(may  Moraxella fever, hearing  Vaccination to
ear. (open eustachian tube be transient or catarrhalis #3 impairment HIB,
allows middle ear pressure long-term)  GAS  Tympanic streptococcus
equalization and drainage  URI  Staphylococcus membrane: red, pneumoniae.
to nasopharynx). It also  Aspiration into aureus inflamed, swollen,  Risk factors: sleep
provides conduit for lung followed by  Mycoplasma bulging, opaque, position, pacifier
pathogens from pneumonia pneumoniae. immobile, blisters, usage, URI,
 nasopharynx.  Bloodstream  More common in air/fluid. rhinitis,
invasion children due to  Anatomic or pharyngitis,
(bacteremia) horizontal inflammatory sinusitis, allergic
 Getspathogen auditory tube. blockage of rhinitis,
fromthe normal drainage secondhand
auditory tube. fosters infection smoke, group
of middle ear. daycare,
abnormal
anatomy (cleft
palate), genetic
factors (antibody
deficiencies, CF,
primary ciliary
dyskinesia).
Recurrent otitis media  >3 episodes of  Tympanostomy/
AOM in 6 mo. Myringotomy
with tube
insertion