DISEASES OF

THE DIGESTIVE SYSTEM

OVERVIEW

OVERVIEW

Many pathogens enter the body when we

ingest water and food.

Defenses of the digestive system are very

strong.

Digestive infections are a major cause of

morbidity and mortality.

BACKGROUND

The mouth and large intestine are crowded

with microorganisms.

Part of the normal oral flora

Digestive diseases are usually associated with:

Crowding

Poor hygiene

Contaminated food or water

BACKGROUND

Digestive infections in developed and

undeveloped countries are associated with
different pathogens.
Developed countries:

Campylobacter

Salmonella

Shigella

Undeveloped countries:

Vibrio cholerae

CLASSIFICATION OF
INFECTION

Infections in the digestive system are classified

in two groups:

Exogenous infections pathogens that come into

the body

Endogenous infections organisms that are part of

the normal microbial flora

EXOGENOUS INFECTIONS

Exogenous infections are brought in with

contaminated food or water.

C. difficile and other exogenous infections are

frequently acquired in hospital environments.

Helicobacter pylori spreads through oral-oral or

fecal-oral contact.

EXOGENOUS INFECTIONS

ENDOGENOUS INFECTIONS

Endogenous infections are caused by

organisms that are part of the normal flora.

Streptococcus and Enterococcus are examples.

In the right circumstances they can cause:

Dental diseases.

DISEASES OF the bowel, appendix, and liver.

Diverticular abscesses.

ENDOGENOUS INFECTIONS

CLINICAL SYMPTOMS OF
GASTROINTESTINAL INFECTIONS

Most common symptoms are:

Fever

Vomiting

Abdominal pain

Diarrhea

The central feature in all cases is diarrhea

CLINICAL SYMPTOMS OF
GASTROINTESTINAL INFECTIONS
The

nature of the diarrhea is used to

classify gastrointestinal infections into
three categories:
Watery diarrhea
Dysentery
Enteric fever

WATERY DIARRHEA

Caused by pathogenic mechanisms that attack

the intestines

Symptoms are usually acute but brief (last 1 to

3 days).

DYSENTERY

Caused by organisms that cause damage to the

colonic mucosa

Either directly or production of toxins

Contain blood and pus

Can be accompanied by cramps, abdominal pain

and little vomiting

Not as much fluid loss as in watery diarrhea but

lasts longer

Most cases resolve in 3 to 7 days.

ENTERIC FEVER

Systemic infection focused in the

gastrointestinal tract.

Prominent features are fever and abdominal

pain.

Pathogens spread to biliary (bile) tract, liver,

and organs of the reticuloendothelial system.

Most investigated form is typhoid fever.

TYPES OF INFECTION

There are five major types of gastrointestinal

infection:

Endemic

Epidemic

Travelers diarrhea

Food poisoning

Nosocomial infections

ENDEMIC GASTROINTESTINAL
INFECTIONS

Defined as infections that occur sporadically

Some are worldwide.

Some are geographically restricted.

There can be seasonal variation.

They can be age-related.

ENDEMIC GASTROINTESTINAL
INFECTIONS

The major pathogens in developed countries

are:

Campylobacter

Salmonella

Shigella

Some organisms geographically restricted to

warm climates:

Vibrio cholerae

EPIDEMIC GASTROINTESTINAL
INFECTIONS

Defined as infections involving regional,

national, and international populations.

Most common epidemic infections are:

Cholera

Typhoid fever

Shigellosis

All are directly related to failures in public

health.

TRAVELERS DIARRHEA

20-50% of travelers to undeveloped countries

will get diarrhea in the first week.
Most studied cases are travelers from the US
to Latin America.

50% of cases are caused by enterotoxigenic strains

of E. coli.

10-20% are caused by Shigella.

The major source is ingestion of improperly

cooked food.

FOOD POISONING
Food

poisoning is usually caused by:

Failing to cook food adequately.

Allowing undercooked food to sit.

Improper storage is an additional factor.

FOOD POISONING

NOSOCOMIAL GASTROINTESTINAL
INFECTIONS

Acquired in a hospital and usually traced to:

Two major pathogens responsible:

Employees.
Contaminated food prepared outside the hospital.
E. coli
C. difficile

C. difficile accounts for 90% of infections.

Symptoms range from mild diarrhea to fulminant

pseudomembranous colitis.
Colitis arises either during or after treatment with
antibiotics.

TREATMENT & MANAGEMENT OPTIONS

FOR GASTROINTESTINAL INFECTIONS

Treatment involves supportive care with liquid

replacement rest.

Infection with E. coli O157:H7 can result in

renal failure.

BACTERIAL DISEASES OF
THE DIGESTIVE SYSTEM

Most common causes:

Escherichia coli (E coli), Salmonella, and

Shigella

Infections causes nausea with or

without vomiting, diarrhea and other
gastrointestinal symptoms.

May also cause bloody diarrhea,

known as dysentery.

BACTERIAL DISEASES OF THE

DIGESTIVE SYSTEM

Bacteria from drinking untreated,

contaminated water or from eating
raw, contaminated produce or
undercooked meat, poultry or eggs.

DENTAL AND PERIODONTAL

INFECTIONS

Many opportunistic pathogens reside in the

mouth.

Most commonly seen infections in the mouth

are:

Dental caries.

DISEASES OF the gum tissue.

In both cases, the major source of infection is

plaque.

FORMATION OF DENTAL
PLAQUE

Tooth surface is normally covered by pellicle.

Bacteria adhere to the pellicle.

Facilitated by bacterial adhesion molecules

Initial adherent is usually Streptococcus mutans

FORMATION OF DENTAL
PLAQUE

FORMATION OF DENTAL
PLAQUE

DENTAL CARIES

DENTAL CARIES (Cavity)

Caries are the single greatest cause of tooth

loss.
Several factors are involved in its
development.

Tooth structure

Types of microflora

Types of substrate available

Saliva normally protects against carries.

DENTAL CARIES

Organisms that produce acid can cause dental

caries.

S. mutans is the major cause.

Other organisms contribute.

Carbohydrates easily enter the plaque and are

readily metabolized.

GINGIVITIS & PERIODONTITIS

There are two forms of plaque-induced

periodontal disease.

Gingivitis

Inflammatory condition

Limited to the marginal surfaces of the gingival

Does not involve loss of bone

Can be corrected

Will continue as long as dental plaque remains

GINGIVITIS & PERIODONTITIS

There are two forms of plaque-induced

periodontal disease.

Periodontitis

Infection of the gingival

Results in loss of supportive bone and ligaments

Responsible for most tooth loss in adults

Treatment
Dental

Care

Take

antibiotics only when

prescribed by your dentist.

Surgery
Visit

for more severe cases

your dentist every 2 months

SALMONELLA TYPHI

TYPHOID FEVER

TYPHOID FEVER
Affecting

an estimated 22 million
people each year

India, Southeast Asia, Africa, South

America

Transmitted

by food/water

PREDISPOSING FACTORS

Work in or travel to areas where

typhoid fever is endemic

Work as a clinical microbiologist

handling Salmonella typhi bacteria

Have close contact with someone

who is infected or has recently been
infected with typhoid fever

DIAGNOSIS

Blood culture

Bone marrow culture

TREATMENT

Chloramphenicol

Ciprofloxacin

Ampicillin

trimethoprim-sulfamethoxazole

VIBRIO CHOLERAE

CHOLERA

CHOLERA

Zero to five cases of cholera are seen

in the United States in a given year

Worldwide, it affects 3-5 million and

causes 100,000-130,000 deaths a
year as of 2010.

Transmitted by food/water

INCIDENCE
Common

in developing countries
in the tropics and subtropics and
most cases occur in Africa

DIAGNOSIS

Blood culture

Stool culture

Rice-water sool

TREATMENT

IV fluids

Oral rehydration solution

Antibiotics: tetracycline, Doxycline

LEPTOSPIRA INTERROGANS

LEPTOSPIROSIS

LEPTOSPIROSIS

Transmitted by

rats and mice

most farm animals

dogs

India, China, Southeast Asia, Africa,

Australia, Central and South America,
The Carribean

PREDISPOSING FACTORS
Camping

in rural areas

People

who are working with

animals

Sewage

workers, farmers

DIAGNOSIS
CBC
Creatine
Liver

kinase

enzymes

Urinalysis

TREATMENT

Ampicillin

Ceftriaxone

Doxycycline

Penicillin

SHIGELLA

SHIGELLOSIS

SHIGELLOSIS

S. dysenteriae, S. boydii S. sonnei,

and S. flexneri

Most cases occur in young children

Transmitted by oral-fecal route

PREDISPOSING FACTORS
Living

or traveling in areas that

lack sanitation

Being

a toddler

Being

a sexually active gay male

DIAGNOSIS

Stool culture

TREATMENT

Sulfamethoxazole

Trimethoprim

Ampicillin

Ciprofloxacin

Azithromycin

CAMPYLOBACTER JEJUNI

CAMPYLOBACTERIOSIS

CAMPYLOBACTERIOSIS

2.5 million cases per year in USA

In developing countries, older
children and young adults have
highest incidence of infection
Transmitted by :

Contaminated milk

Contaminated food

Poultry, livestock or household pets

PREDISPOSING FACTORS

Consumption of poultry and poultry

products

Drinking untreated water-consuming

unpasteurized milk

DIAGNOSIS

Gram stain

Stool culture

TREATMENT

Azitrhomycin

BACILLUS CEREUS

FRIED RICE SYNDROME

FRIED RICE SYNDROME

Common in Northern Europe and

Canada

If the rice is not refrigerated properly

after being steamed, the bacteria
thrives and multiplies rapidly.

Transmitted by food

PREDISPOSING FACTORS

Storage of boiled rice

Cooking frequency per dining session

DIAGNOSIS

Isolation of B. cereus organism

TREATMENT

Oral rehydration or intravenous fluid

and electrolyte replacement

OTHER BACTERIAL
DISEASES

Gastric ulcer

Clostridial food poisoning

Staphylococcal food poisoning

Pseudomembranous colitis

FUNGAL DISEASE OF
DIGESTIVE SYSTEM

Mycotoxins are toxins produced by

some fungi.

It affects the blood, nervous system,

kidneys, or liver.

CLAVICEPS PURPUREA

ERGOT POISONING OR
ERGOTISM

ERGOT POISONING OR
ERGOTISM

Produced due to fungal

contamination of grains

Cereal grains

Transmitted by:

Ingestion of Claviceps purpurea

Ingestion of fungus infected rye

INCIDENCE/PREVALENCE

Open-flowering and male-sterile

cereals

Large reservoir of inoculum amongst

grasses.

Prevalent throughout Britain

DIAGNOSIS

Stool exam

TREATMENT

Nifedipine

ASPERGILLUS FLAVUS

AFLATOXIN POISONING

AFLATOXIN POISONING

They can colonize and contaminate

grain before harvest or during
storage.

Peanuts are the crop most often

contaminated

Toxin is carcinogenic in humans and

can also cause other health effect,
particularly liver problems

INCIDENCE

The condition is most common in

poorly developed countries.

The American Food and Agriculture

Organization estimates that 25% of
the food crops in the world are
affected by mycotoxins. Of these
mycotoxins, aflatoxins are the
biggest problem.

DIAGNOSIS

Stool exam

Liquid chromatography-tandem mass

spectrometry

TREATMENT

Chemical treatment via ammoniation

Reaction with sodium bisulfite

VIRAL DISEASES OF THE

DIGESTIVE SYSTEM

Digestive system is an important portal of

entry for viruses.

For some it is only an entry point

Most common sign of viral infection is

diarrhea.

VIRAL DISEASES OF THE

DIGESTIVE SYSTEM

Several groups of viruses cause

gastrointestinal infections:

Rotavirus

Calicivirus

Astrovirus

Some serotypes of adenovirus

Enterovirus

VIRAL DISEASES OF THE

DIGESTIVE SYSTEM

Infections all have similar characteristics

Brief incubation periods

Fecal-oral routes of transmission

Vomiting that either precedes or accompanies

diarrhea

VIRAL DISEASES OF THE

DIGESTIVE SYSTEM

ROTAVIRUS

ROTAVIRUS

Not discovered until 1973

Now found around the world

Believed to account for 40 - 60% of cases of

acute gastroenteritis

Can undergo genetic re-assortment

Difficult to deal with immunologically

ROTAVIRUS
Most

common cause of severe diarrhea

among infants and young children

Outbreaks

of rotavirus infections
common in infants and children under 2.

Adults are usually only minimally affected.

Can affect the elderly or institutionalized

Usually causes little or no clinical illness

ROTAVIRUS
Rotavirus

infections kill more than 1

million infants worldwide each year.

In the US there are fewer than 100 deaths

each year.

Infection is still a major cause of

hospitalization early in life.

MODE OF TRANSMISSION

Fecal-oral route

Contact with contaminated hands,

surfaces and objects

Possibly by the respiratory route.

DIAGNOSIS

Enzyme-linked immunosorbent assay

(ELISA)

Electron microscopy

PCR (polymerase chain reaction)

TREATMENT

Maintenance of hydration

low-osmolarity oral rehydration

solution and zinc supplementation

ENTEROVIRUS

ENTEROVIRUS

Enteroviruses are members of the

picornaviridae.

Very resistant to acidic environments

Humans are the natural hosts.

ENTEROVIRUS

Transmission is by direct or indirect fecal-oral

route.

Virus will normally spend 1 to 4 weeks in the

oropharynx.

ENTEROVIRUS INFECTION:
Pathogenesis

60% of infections occur in children of 9 and

younger.

Incubation time is 2 to 10 days.

Virus is brought into the host cell by

envelopment in the host membrane.

ENTEROVIRUS INFECTION:
Pathogenesis
Enteroviruses

are lytic.

End result is destruction of host cell

Primary

infection in the digestive

system

Spreads to other sites

TREATMENT OF ENTEROVIRUS
INFECTION

None of the currently available antiviral agents

is effective.

HEPATITIS VIRUSES

HEPATITIS VIRUSES

Hepatitis describes any disease that affects the

hepatocytes of the liver.

At least 6 different viruses cause hepatitis

HEPATITIS VIRUSES

Humans are the most common natural host.

Transmission is usually via the fecal-oral
route.

Infections are common where there is crowding

and poor hygiene.

Rates of infection are higher in lower

socioeconomic groups.

Up to 90% of the population of developing nations

show evidence of previous infection.

HEPATITIS INFECTION:
Pathogenesis

Infection often results from poor personal

hygiene in food handlers.

Virus is believed to replicate initially in

intestinal mucosa

HEPATITIS INFECTION:
Pathogenesis

Multiplication in the intestines is followed by

spread to liver

Extent of necrosis correlates to the severity of

infection.

HEPATITIS INFECTION:
Pathogenesis

Immune response is protective.

Patients with antibodies cannot be reinfected.

Incubation times vary from 10 to 50 days,

followed by:

Fever
Anorexia
Nausea
Pain in the abdomen
Jaundice

HEPATITIS INFECTION:
Pathogenesis

In infected patients with jaundice:

Urine becomes dark.

Stool can become clay-colored 1 to 5 days before

onset of jaundice.

HEPATITIS INFECTION:
Treatment

No drugs are effective supportive measures

are recommended.

There is an active immunization protocol for

those who are repeatedly exposed to hepatitis
A virus.

Mumps

Oral herpes

Viral gastroenteritis

PARASITIC DISEASES OF THE

DIGESTIVE SYSTEM

Several protozoan and helminthic diseases of

the human digestive system

Common parasitic diseases are caused by:

Giardia

Cryptosporidium

Whipworms

Hookworms

HELMINTHIC DISEASE OF
DIGESTIVE SYSTEM

ASCARIS LUMBRICOIDES

ASCARIASIS

ASCARIASIS

Large Intestinal Roundworm

The disease is acquired by ingesting

Ascaris eggs.

The eggs can remain viable in the

soil for several months or even years.

ASCARIASIS

More than 2 billion people are

affected by this infection.

One study indicated that the

prevalence of ascariasis in the United
States at about 4 million (2%)

PREVALENCE

Perhaps as many as one quarter of

the world's population are infected,
with a prevalence of 45% in Latin
America and 95% in parts of Africa.

MODE OF TRANSMISSION

Ingestion of Embryonated egg

through contaminated food or water

DIAGNOSIS

Concentration methods and Direct

Fecal Smear: Kato-Katz

TREATMENT

Albendazole

Mebendazole

Pyrantel pamoate

TRICHURIS TRICHIURA

TRICURIASIS

TRICURIASIS

Infects a human large intestine

Found in Tropical Areas

There is a worldwide distribution of

Trichuris trichiura, with an estimated
1 billion human infections.

PREVALENCE

50 to 80 percent in some regions of

Asia (noted especially in China and
Korea) and also occurs in rural areas
of the southeastern United States.

Infection is most prevalent among

children, and in North America,
infection occurs frequently in
immigrants from tropical or subtropical regions.

MODE OF TRANSMISSION

Fecal-oral contamination

DIAGNOSIS

Stool ova and parasites exam

Kato-Katz thick-smear technique

Colonoscopy

TREATMENT

Mebendazole

Albendazole

Ivermectin

ENTEROBIUS
VERMICULARIS

ENTEROBIASIS

ENTEROBIASIS

Human parasitic disease and one of

the most common childhood parasitic
worm

Infection usually occurs through the

ingestion of pinworm eggs, either
through contaminated hands, food,
or less commonly, water.

PREVALENCE

Pinworms are particularly common in

children, with prevalence rates in this
age group having been reported as
high as 61% in India, 50% in
England, 39% in Thailand, 37% in
Sweden, and 29% in Denmark.

MODE OF TRANSMISSION

Human-to-human

By ingesting (swallowing) infectious

pinworm eggs.

DIAGNOSIS

Diagnostic Exam: Scotch Tape Swab

TREATMENT

Mebendazole

Albendazole

FASCIOLA HEPATICA

FASCIOLOSIS

FASCIOLOSIS

Human fasciolosis has been reported

from countries in Europe, America, Asia,
Africa and Oceania. The incidence of
human cases has been increasing in 51
countries of the five continents.
In addition, fasciolosis is now
recognized as an emerging human
disease: the World Health Organization
(WHO) has estimated that 2.4 million
people are infected with Fasciola, and a
further 180 million are at risk of
infection

MODE OF TRANSMISSION

Intermediate snail hosts,

Domestic herbivorous animals,

DIAGNOSIS

Stool examination

ELISA

Western blot.

TREATMENT

Nitazoxanide

Triclabendazole

Bithionol

TAPEWORMS

TAPEWORMS

Taenia Solium - pork

Taenia Saginata- beef

Diphyllobothrium latum- fish

TAENIASIS

TAENIASIS

Most occurrences are found in areas

which lack adequate sanitation

Southeast Asia

West Africa

East Africa

Usually cause no symptoms

Some people experience upper
abdominal discomfort, diarrhea, and
loss of appetite.

MODE OF TRANSMISSION

Blood to blood contact

Eating the raw meat of an animal

infected with tapeworms

DIAGNOSIS

Stool examination

Inject gravid proglottid with India ink

Scotch tape test for the eggs

TREATMENT

Mebendazole

Praziquantel

Niclosamide

OTHER HELMINTHIC
DISEASE

Schistosomiasis

Paragonimiasis

Clonorchiasis

Strongyloidiasis

Cysticercosis

Diphyllobothriosis

Intestinal capillariasis

PROTOZOAN DISEASE OF
DIGESTIVE SYSTEM

Giardiasis

Amoebiasis

Balantidiasis

Isosporiasis

Cryptosporidiosis

GIARDIA LAMBLIA

GIARDIASIS

GIARDIASIS

Common cause of gastroenteritis in

humans, infecting approximately 200
million people worldwide.

One of the most common water

borne gastrointestinal diseases in the
United States.

PREVALENCE

Areas with inadequate sanitary

conditions

Among people living in developed

countries

Tropics and subtropics area

MODE OF TRANSMISSION

Fecal-oral route

Personal contact

Contaminated water and food

By not washing their hands after

touching something contaminated
with Giardia cysts

MODE OF TRANSMISSION

DIAGNOSIS

Stool microscopy

TREATMENT

Metronidazole

Tinidazole

Quinacrine

Paromomycin

ENTAMOEBA HISTOLYCTICA

AMOEBIASIS

AMOEBIASIS

A gastrointestinal infection that may

or may not be symptomatic and can
remain latent in an infected person
for several years, amoebiasis is
estimated to cause 70,000 deaths
per year world wide

Can cause severe diarrhea with

blood.

PREVALENCE/ INCIDENCE

Amoebiases occurs worldwide,

although much higher rates of
incidence are found in the tropics
and subtropics. About 5,000 to
10,000 cases are diagnosed each
year in the US, leading to about 20
deaths annually.

MODE OF TRANSMISSION

Contaminated food/water

Fecal-oral route

Anal-oral contact

PREDISPOSING FACTORS

Poor sanitary conditions

Commonly affects active homosexual

men

Immigrants from developing

countries

DIAGNOSIS

Fecal microscopic analysis

TREATMENT

Metronidazole

Paromomycin

Amoebicide

BALANTIDIUM COLI

BALANTIDIASIS

BALANTIDIASIS

The first case of Balantidiasis in the

Philippines, where it is the most
common, was reported in 1904.

Currently, Balantidium coli is

distributed worldwide but less than
1% of the human population is
infected.

BALANTIDIASIS

Symptoms can be local due to

involvement of the intestinal
mucosa, or systemic in nature and
include either diarrhea or
constipation.

MODE OF TRANSMISSION

Contaminated food/water

When a patient has diarrhea

combined with a probable history of
current exposure to amoebiasis

Travel

contact with infected persons

Anal intercourse.

DIAGNOSIS

Fecal analysis

TREATMENT

Tetracycline

Metronidazole

Iodoquinol

ISOSPORA BELLI

ISOSPORIASIS

It is found worldwide, especially in

tropical and subtropical areas.

Infection causes acute, non-bloody

diarrhea with crampy abdominal
pain, which can last for weeks and
result in malabsorption and weight
loss.

ISOSPORIASIS

In immunodepressed patients, and in

infants and children, the diarrhea can
be severe.

MODE OF TRANSMISSION

Contaminated food/water

DIAGNOSIS

Fecal analysis

Typical laboratory analyses include:

Microscopy

Morphologic comparison with other

intestinal parasites

Bench aids for Isospora

TREATMENT

Trimethoprim-sulfamethoxazole

CRYPTOSPORIDIUM

CRYPTOSPORIDIOSIS

CRYPTOSPORIDIOSIS

Affects the intestines and is typically

an acute short-term infection

the main symptom is self-limiting

diarrhea in people with intact
immune systems.

CRYPTOSPORIDIOSIS

It is found worldwide. It causes

50.8% of water-borne diseases that
are attributed to parasites.

The age group most affected is

children from 1 to 9 years old.

MODE OF TRANSMISSION

By the fecal-oral route

Directly from person to person

Contaminated drinking water and

swimming pools and to petting
infected animals

Contaminated food

PREVALENCE/ INCIDENCE

0.5 to 2 million undiagnosed cases

each year

DIAGNOSIS

Examination of stool samples

Stool microscopy

TREATMENT

Nitroxonide

Paromonomycin

Clarithromycin

Azithromycin

OTHER PROTOZOAN
DISEASE

Sarcosporidiosis

Gum disease

POP QUIZ!

1. CHOLERA
A.CAMPYLOBACTER JEJUNI
B. VIBRIO CHOLERAE
2. Organisms that are part of the
normal microbial flora
A. ENDOGENOUS INFECTIONS
B. EXOGENOUS INFECTIONS
3. FRIED RICE SYNDROME
A.SHIGELLA
B. BACILLUS CEREUS

4. ASCARIASIS
A. ASCARIS LUMBRICOIDES
B. ASCARIS LUMBERICOIDE
5. TAENIA SOLIUM
A. BEEF
B. PORK
6. TREATMENT FOR ERGOT
POISONING
A. NIFEDIPINE
B. MEBENDAZOLE

7. Treatment for Ascariasis

is SCOTCH TAPE SWAB? Y/N

8. ERGOT POISONING
A. CLAVICEPS PURPUREA
B. ASPERGILLUS FLAVUS

9. TREATMENT FOR
AMOEBIASIS IS NIFEDIPINE?
Y/N

10.
A. ROTAVIRUS
B. HEPATITIS VIRUS