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CAMPYLOBACTER AND HELICOBACTER

CAMPYLOBACTER AND HELICOBACTER. CAMPYLOBACTER. Gram negative, curved,microaerophilic bacteria found in the intestine of animals. Known to cause animal infection for many years Recently associated with human infections

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CAMPYLOBACTER AND HELICOBACTER

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  1. CAMPYLOBACTER AND HELICOBACTER

  2. CAMPYLOBACTER • Gram negative, curved,microaerophilic bacteria found in the intestine of animals. • Known to cause animal infection for many years • Recently associated with human infections • Diseases range from mild diarrhea to dysenery to septicemia and complications

  3. Common species

  4. Bacteriology • Gram negative, curved or S shaped bacilli (gull winged shape) • Motile with uni / bipolar flagellae • Microaerophilic • Non fermenting • Oxidase positive

  5. Electron micrograph showing polar flagella Gram’s stain

  6. Major virulence factors • Motility • Invasion • Enterotoxins

  7. Pathogenesis • Source of infection –infected animals, contaminated food ( raw milk, poutry etc), patients • Transmission – ingestion of contaminated food, pet animals,feco oral rarely homosexual • Incubation period – 5-7days • Bacteria colonises small and large intestine, invades and produces enterotoxins

  8. Diseases • Watery diarrhea • Bloody diarrhea also with fever, abdominal pain. • Bacteremia and septicemia • May cause meningitis • Associated with Guillian Barre Syndrome Disease takes severe form in immunocompromised patients and young children

  9. Laboratory diagnosis • Fecal specimen and blood • Feces transported in Cary Blair medium • Culture media: Blood agar with antibiotics – Campy agar, Skirrows medium. • Incubation in microaerophilic environment

  10. feces Hanging drop – motility Culture Gram negative curved bacilli Blood cells & pus cells Biochemical identification may be present oxidase + non fermenter Presumtive diagnosis hippurate hydrolysis+ Definitive diagnosis

  11. Treatment • Erythromycin • Ciprofloxacin • doxycycline

  12. Helicobacter pylori • Gram negative, spiral shaped, motile, urease producing bacteria • First cultured in 1982(Marshall & Warren in Australia) – called campylobacter pylori • Later renamed Helicobacter pylori in 1989 • Inhabits mucus overlying gastric mucosa • Revolutionized the study of gastro duodenal infection

  13. Epidemiology • Found in the stomach of individuals in all parts of world. • Also found in non human primates • Developing countries – 70-90% carry H.pylori, majority acquire in <10 yrs age • Developed countries – 25-50%, acquire in <20 yrs

  14. Risk factors • Infected family member • Crowded living conditions • Clustering in day care centers, institutions • Poor sanitation • Poor hygeine • Hypo / Achlorhydria

  15. Transmission • Fecal – oral • Oral – oral • Iatrogenic via contaminated instruments like scopy

  16. Virulence factors • Motility & spiral shape • Urease • Phospolipase • Mucinase • Cytotoxins • adhesins

  17. Pathogenesis • Entry into gastric mucus • Attachment to gastric epithelial cells, mainly pylorus • Evasion of immune response • Persistent colonisation • Disease • Transmission

  18. Disease association Self ingestion leads to gastritis; specific therapy cures • Chronic gastritis, may be asymptomatic • Peptic ulcer disease • Atophic gastritis • Gastric adenoma • Gastric lymphoma

  19. Lab diagnosis Using invasive methods – endoscopic biopsy • Histological examn of gastric tissue • Culture • Rapid biopsy urease test • DNA probe • PCR

  20. Non invasive methods using gastric fluid, serum saliva, urine • Urea breath test • Serology – good epidemiological tool • Gastric juice PCR

  21. Methods Specimen transported in Stuarts medium or saline Histopathology using H & E stain, Giemsa, Warthin-Starry Silver stain, Alcian blue

  22. Gastric biopsy

  23. Colonisation of gastric mucosa by H.pylori

  24. H.pylori in antral gland

  25. Culture using chocolate agar , campylobacter selective media • Requires microaerophilic environment with added CO2 • Identified using colony morphology and biochemical reactions

  26. Urea breath test • Rapid reliable test for H.pylori infection • Ingestion of C labelled urea • Urease of bacteria breaks urea releasing labelled carbon • Exhaled carbon measured

  27. Treatment Antibiotic + proton pump inhibitors + bismuth salts • Using these combinations various regimens available • Triple therpy • Quadruple therapy • Dual therapy

  28. Antibiotics: Metronidazole, Erythromycin, Clarithromycin, Amoxicillin, Tetracycline PPI: omeprazole, ranitidine Bismuth salts: salycilate or subcitrate

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