INFEKSI

GASTROINTESTINAL
Enterobacteriaceae
• Famili bakteri gram negatif yang biasa ditemukan
pada saluran pencernaan manusia dan hewan.
• Terdapat lebih dari 25 genus dan 110 spesies
• Genus (escherichia, shigella, salmonella,
enterobacter, klebsiella, serratia, proteus, dan lain
sebagainya)
 Bakteri basil, gram negative (-), 2-4, 1-5 μm
 Capsule, slime layer, neither
 Pili
 Flagella
 Motil kecuali Klebsiella, Shigella dan Yersinia
 Aerobe & Fakultative anaerob
 Semua memfermentasi glukosa(dextrose)
 Lactose +/- (mc. Conkey, endo)
+ : Escherichia, Klebsiella,
- : Salmonella, Shigella, and Yersinia
 Semua mereduksi nitrat menjadi nitrit (X Photorhabdus)
 All are oxidase negative (X Plesiomonas shigelloides)
 Catalase (+)
 Virulence Factors

- Adherence factor : phili

flagella (Antigen H)
capsule : Antigen K & Vi
- Endotoxin: lipid A
- exotoxin: ST (heat stable), LT (heat labile), SLT
(shiga-like toxin)
- Bacteriocin
- Hemolisin
- etc
 Antigen
 Antigen O (somatic) : Polisakarida
 Resisten terhadap panas dan alkohol.
 Dapat dideteksi dengan Tes Aglutinasi
 Antibodi terhadap antigen ini sebagian besar IgM
 Berhubungan dengan penyakit pada manusia :
 antigen O pada E. Coli menyebabkan diare
 Antigen H : flagella (protein)
 Dapat didenaturasi dengan pemanasan dan alkohol.
 Aglutinasi dengan antibodi anti-H dan IgG
 Antigens K : kapsul (protein, beberapa polisakarida).
 Berhubungan dengan virulensi :
 Antigen K pada E coli menyebabkan penempelan bakteri pada sel
epitel GIT dan invasi pada saluran kemih.
- Opportunistic pathogen:
Citrobacter, Enterobacter, Escherichia,
Morganella, Providencia and Serratia, proteus
(septicemia, pneumonia, meningitis and
urinary tract infections, etc)
- True pathogen:
Salmonella, Shigella, Yersinia, some strains of
E. coli
E.coli
  Flora normal in intestine
 Gram-negative
 Family Enterobactericeae
 Basil-soliter
 flagella peritric
 antigen O, K, dan H
E.coli

 Optimum temp 37˚C

 Ferment lactose
 Aerob & fakultative anaerob
 Mikroaerofilik
 haemolysis tipe β (some)
 Non-spore
  Uji biokimia :
 Indol (+)
 Asetat (+)

 Peragian laktosa (+)

E.coli

 Gas & glukosa (+)

 Lisin dekarboksilase (+/-)

 Motilitas (+/-)

 Hemolisis tipe B (+/-)

  Mosly harmless
 The pathogenic:
 UTI (urinary tract infection), 90% in first UTI...
Simptoms?
E.coli

 Diarrhea (EPEC, ETEC, EHEC, EIEC, EAEC)

 Sepsis (inadequate host defence - e coli reach

bloodflow)
 Meningitis (in infant)
  Enterovirulent E. coli are divided into 5 groups according to
their action in the body (in GIT):
1. Enteropathogenic (EPEC) - responsible for severe infantile
diarrhoea.
2. Enterotoxigenic (ETEC) - produces a heat labile (LT) or heat
stable (ST) toxin. Both may be produced by the same organism.
They are responsible for cases of paediatric diarrhoea, severe
cholera-like illness, and traveller’s diarrhoea (watery diarrhea,
febrile, nausea) (small intestine)
E.coli

3. Enteroinvasive (EIEC) - pathogenicity is due to invasion of

the gut mucosa. They give rise to a dysentery-like illness.
4. Enterohaemorrhagic (EHEC) - responsible for bloody
diarrhoea and hemorragic colitis. (Shiga-like toxin ) , but fever is
not prominent and the bloody discharges are copious rather
than scanty.
5. Enteroaggregative (EAEC): Biofilm (small intestine +colon)
causes chronic diarrhea and growth retardation in infants in
developing countries
E.coli
E.coli
  Shigella (4 species; S. flexneri, S. boydii, S.
sonnei , S. dysenteriae)
 bacillary dysentery or shigellosis (bloody
feces associated with intestinal pain).
 Shiga toxin (chromosomally-encoded), which is
Shigella

neurotoxic, enterotoxic and cytotoxic.

 Nonspore, nonmotile, non lactose fermenting
Shigella
 Symptoms
 usually develop about 1 to 7 days (average 3 days)
after you come in contact with the bacteria.
 Symptoms include:
Shigella

 Acute (sudden) abdominal pain or cramping

 Acute (sudden) fever
 Blood, mucus, or pus in stool
 Crampy rectal pain (tenesmus)
 Nausea and vomiting
 Watery diarrhea
  Exams and Tests
 Dehydration with fast heart rate and low
blood pressure
 Abdominal tenderness
Shigella

 Elevated white blood cell count

 Stool culture
 White blood cells in stool
  gram-negative rods
 O, H, and Vi antigens
 Facultative anaerobic,
Salmonella

 Motile (flagella peritic)

 glucose-fermenting,
 Non-lactose fermenting
 H2S+
 Intracellular pathogen
 Acid tolerant response
 - enteric or typhoid fever (primarily Salmonella
typhi and Salmonella paratyphi)
- enterocolitis (typically Salmonella typhimurium,
Salmonellosis

Salmonella enteritidis, and Salmonella heidelberg).,

- other infection : bacteremia, endovascular

infections, focal infections (eg, osteomyelitis >
komplikasi pada pasien dengan penyakil sickle cell
atau HIV), and asimptomatic (carrier)
  Some infectious disease texts recognize three clinical forms of salmonellosis: (1)
gastroenteritis, (2) septicemia, and (3) enteric fevers. This chapter focuses on the
two extremes of the clinical spectrum—gastroenteritis and enteric fever
 gastroenteritis (food poisoning) depends on the dose of bacteria. Symptoms
usually begin 6 to 48 hours after ingestion of contaminated food or water and
usually take the form of nausea, vomiting, diarrhea, and abdominal pain. Myalgia
and headache are common; however, the cardinal manifestation is diarrhea.
Fever (38°C to 39°C) and chills are also common. At least two-thirds of patients
complain of abdominal cramps. The duration of fever and diarrhea varies, but is
Salmonellosis

usually 2 to 7 days.
 Enteric fevers are severe systemic forms of salmonellosis. The best studied enteric
fever is typhoid fever, the form caused by S typhi, but any species of Salmonella
may cause this type of disease. The symptoms begin after an incubation period of
10 to 14 days. Enteric fevers may be preceded by gastroenteritis, which usually
resolves before the onset of systemic disease. The symptoms of enteric fevers are
nonspecific and include fever, anorexia, headache, myalgias, and constipation,
diarrhea, roseola in trunk, . Enteric fevers are severe infections and may be fatal if
antibiotics are not promptly administered.

 DIAGNOSIS :
 kultur tinja selama 2 hari,
 tes aglutinasi : titer antibodi antigen O dan H (tes widal) pada minggu pertama setelah onset
awal,
 kultur darah dan sumsum tulang
  Bakteri gram negatif (-)
 Helix-shaped
 Mikroaerophilic
Helicobacter pylori

 Flagella lopotric (4-7) , motile

 Spora (-)
 Katalase (+), Oksidase (+), Urease (+)
 Transmision : fecal-oral
 Patogenitas : adhesi pada sel epitel gaster.
Urease (urea  amonia) – neutralize acid
vacuolizing cytotoxin (VacA) merusak sel epitel
Helicobacter pylori
Helicobacter pylori
Helicobacter pylori
  fecal antigen test
 Urea breath test  carbon (urea)
Helicobacter pylori

 Blood test  antibody

 biopsi gaster kultur , ditanam dalam media
kaya nutrisi dan selektif dengan kondisi
microaerob (90% N2, 5% CO2, and 5% O2) tiga
sampai empat hari. Identifikasi : adanya
oxidase, katalase, dan urease
 endoscopy
Infection
Gastritis type B
Gastric ulceration
Duodenal ulceration
Gastric adenocarcinoma
Gastric lymphoma (MALT)
Gastroenteritis/enterocolitis
Bacteria
Pseudomembranous colitis (often Clostridium difficile
antibiotic associated)
Shigellosis (dysentery)
Salmonellosis
Enteric form
Typhoid form
Cholera
Most important pathogen Diagnosis
Helicobacter pylori Direct fecal antigen detection,
Biopsy and histopathology
Urea breath test
Culture from biopsy
Serology for screening
Staphylococcus aureus intoxication (enterotoxins A-E) Toxin detection (with antibodies) in food and
Clostridium perfringens (foods) Stool
Vibrio parahaemolyticus (food, marine animals) Culture (quantitative) from food and stool
E. coli (EPEC, ETEC, EIEC, EHEC, EAggEC) Culture from stool
No simple tests available; if necessary:
culture from stool and identification of
Campylobacter jejuni pathovars by means of DNA assay; serovar
Yersinia enterocolitica may provide evidence
Bacillus cereus Culture from stool
Culture from stool
Culture from stool
Toxin detection (cell culture) in stool.
DNA assay for toxin possible
Shigella spp. Culture from stool
Salmonella enterica (enteric serovars) Culture from stool
Salmonella enterica (typhoid serovars) Culture from blood and stool; serology
(or possibly enteric salmonellae in predisposed (Gruber-Widal results of limited significance)
persons)
Vibrio cholerae Culture from stool, possibly
also from vomit