Diseases of the gastrointestinal tract Components of digestive tract (and sites of infection) Normal flora and other pro

1. Diseases of the gastrointestinal tract Components of digestive tract (and sites of infection) Normal flora and other protective mechanisms Pathogenesis many candidates: notice all of the tables in this chapter!

2. Structure of the digestive system • Ingestion (mouth) • Digestion (mouth, stomach, small intestine) • Accessory organs (liver, pancreas, gall bladder) • Absorption (small, large intestine • Excretion (large intestine)

3. The oral cavity • Many resident bacteria • Some bacteria cause plaque (e.g., S. mutans, Actinomyces) • Caries- breakdown of enamel • Periodonal disease • Can cause systemic complications

4. Other infections of the mouth • Mumps • spreads from upper respiratory tract to salivary glands; can spread to meninges and/or testes • Vaccine available since 1967 (MMR) • Thrush (C. albicans) • Herpes simplex type 1 (cold sores)

5. Bacterial infections of the GI tract “Food poisoning”- toxins, other contaminants toxins are already formed so onset is rapid Termed intoxication) S. aureus toxin is problematic because it is heat-stable Symptoms: diarrhea, pain, nausea, vomiting usually no immunity established “When in doubt, throw it out”

6. Bacterial (gastro-)enteritis: organism causes disease, not exotoxin Diarrhea- small intestine affected Dysentery- large intestine (blood, pus) Enteric fever- systemic Salmonella many distinguishable types (serovars) very common; usually spread by improperly perpared food symptoms occur about 48 hours after infection invades mucosa in small, large intestines

7. Shigella- not as invasive as Salmonella, but very contagious bloody diarrhea S. dysenteriae produces a neurotoxin Vibrio- cholera outbreaks occur when sanitation is disrupted Enterotoxin makes interstines permeable to water; patients lose massive amounts fluid replacement, vaccination Many other organisms produce enterotoxins (E. coli, Campylobacter, etc.

8. Intestinal pathogens have different modes of activity Cholera toxin Invasiveness of Shigella

9. H. pylori • First cultured in 1982 (Marshall and Warren) • Generates ammonia from urea • Causes peptic ulcers • Linked to chronic gastritis, stomach cancer

10. Most infectious enteritis probably caused by viruses Rotavirus (esp. young children) tends to be seasonal Norwalk virus (now norovirus) very common in adults 2-day incubation period See Table 25.11 Poliovirus: introduced by fecal-oral route but does infect digestive system

11. Comparison of hepatitis viruses (now table 25.12)

12. Parasitic diseases of the digestive system • Often transmitted from other animals • Food (beef, fish, pork, etc.) • Incidental contact (soil, insects, feces) • Helminths: Flukes, tapeworms (cestodes) roundworms (nematodes) • Often symptoms are subtle or nonexistent • Can infect diverse tissues • Requires antihelminthic drugs for treatment

13. Infections by protozoans • Giardia, Cryptosporidium, Cyclospora, Entamoeba, etc. • Cyst is hard to eliminate • Clean drinking water is important • Cyclospora spread on contaminated food • Have complex life cycles • Invasion of tissues; inflammation

14. Fungal toxins can be deadly • Aflatoxins (moldy grain, peanuts) • Strong carcinogens • Ergot (rye, wheat) can cause hallucinations; can be medicinal • Mushroom toxins mainly produced by Amanita; toxic to liver

15. Summary • Substantial opportunities for infection • Bacterial/viral: no cure or lasting immunity • Drugs for protozoan or helminthic infections are toxic • Vaccines limited (and often inappropriate) • Avoidance • Hydration therapy