answer from the powerpoint

Chapter 09

Bacterial Diseases (minus STDs and Vectorborne)

Public Health 4030

9/19/2017 1Ch. 09 - Bacterial Diseases

Foodborne and Waterborne Bacterial Diseases • Food-borne diseases in the U.S. are estimated at 76 million

each year – of which 325,000 are hospitalized

• Food Intoxication (Food Poisoning): Ingestion of bacterial toxins (with or without the microbe being present) • Nausea, vomiting, and diarrhea • Some cases result in numbness and tingling around lips and may cause

damage to nerves and organs • Symptoms appear quickly because toxin acts on body

• Foodborne infection: bacteria multiply in the intestinal tract, secrete an enterotoxin, and may invade cells of the intestinal tract • Enterotoxins cause symptoms of nausea, vomiting, diarrhea, and,

possibly, bloody stools • Can start as early as one hour after eating and as late as 10 days later

• Some parasite infections take months to develop symptoms

• Symptoms can last from one day to months

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Food Intoxication (Food Poisoning)

Botulism is caused by the deadly botulinum neurotoxin of Clostridium botulinum, a g+ spore-forming bacillus, found in soil • Improperly home-canned string beans, peppers,

asparagus, sausage, cured pork and ham, smoked fish, and canned salmon (low acid content foods)

• Therapy: antitoxin and mechanical ventilation • Botox: removes wrinkles, reduce muscle

overactivity

Clostridium perfringens food poisoning, when spores contaminate meat, poultry, and beans

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Food Intoxication (Food Poisoning)

Staphylococcal food poisoning is caused by Staphylococcus aureus, a g+ coccus • Most common type of food poisoning

• Approximately 241,000 illnesses per year in U.S. • Probably under reported – not a notifiable disease

• Found in human nasal passages • Heat stable enterotoxin

− Symptoms, abdominal cramps, nausea, vomiting, and diarrhea

− Symptoms appear within a few hours, very severe

• Treatment includes: rest, plenty of fluids, and meds to calm stomach • Antibiotics are not useful – does not treat toxin

Courtesy of Matthew J. Arduino, DRPH/CDC 9/19/2017 Ch. 06 - Bacterial Diseases 5

Foodborne and Waterborne Infection

Salmonellosis is caused by several species of g- bacilli in the genus Salmonella

• Approximately 40,000 cases each year in U.S. • Probably 30X greater due to under reporting • Symptoms include (a gastroenteritis) nausea,

vomiting, abdominal cramps, diarrhea, and possibly fever

• Symptoms develop 12 – 72 hours after infection • Lasts for 5 – 7 days • Treatment includes managing symptoms and

preventing dehydration

• Antibiotics are not necessary unless spreads from intestines

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Salmonella enteritidis

• Salmonella lives in intestinal tracts of humans and other animals

• Transmitted to humans by eating foods contaminated with animal feces

• Salmonella may contaminate meats, seafood, and fresh fruits and vegetables

• Iguanas, lizards, snakes, and turtles are carriers of a variety of salmonella species

• Prevention: No vaccine to prevent

• Do not eat raw or undercooked eggs, poultry, or meat

• Wash hands regularly and thoroughly – especially after handling wildlife or when preparing food

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Salmonella typhi – causes typhoid fever

• Typhoid occurs primarily in less-developed countries • Typhoid Mary was a healthy carrier

• Infection is from fecally-contaminated food or hands

• Transmission by flies and fomites is also common

• The organism invades the cells lining of the small intestines, causing ulcers and bloody stools, fever, and possibly delirium

• Treatment: Antibiotics & wash hands

• Prevention: Two vaccines available – neither 100% effective and requires repeated immunization • Wash hands, avoid eating raw foods, untreated

water

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Shigellosis

• Caused by several species of Shigella, a g- bacillus

• Approximately 500,000 cases in U.S. each year • Symptoms are gastroenteritis, and possibly dysentery

• Severe diarrhea containing blood and mucus • Resultant dehydration can be deadly • Symptoms occur generally 1 – 2 days after infection and

lasts 5 – 7 days • Sources: eggs, shellfish, dairy products, vegetables, water • Transmission via the fecal–oral route, infectious dose (ID) is very low

• Treatment involves oral or IV rehydration and possibly antibiotics

• About one million annual deaths in developing countries

• Prevention: No vaccine – Wash hands before eating and after changing diapers

• Antibiotic resistance is an urgent threat with Shigellosis

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Cholera intoxication

• Caused by the exotoxin secreted by the g-, curved rod, Vibrio cholerae

• Consuming fecally-contaminated water or food (including raw shellfish) causes infection

• Pandemics documented over the centuries • Rare in U.S.

• In 2016, WHO reported 132,121 (2,420 deaths) – 54% Africa, 32% Hispaniola

• Poverty, overcrowding, and poor sanitation favor the emergence and dissemination of cholera

• Characteristic of cholera is a voluminous rice-water diarrhea

• Rehydration must be instituted quickly to avert death

• Oral rehydration therapy can save lives

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Enterotoxigenic E. coli

• E. coli normally lives in intestine of people and animals are harmless and important to human health

• Six pathotypes are associated with diarrhea

• Enterotoxigenic E. coli is the most common cause of traveler’s diarrhea • E. coli is easy to culture and detect; its

presence is used as an indicator of fecal contamination

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E. Coli O157:H7

• Contaminates rare meat, particularly hamburgers, also fresh spinach, sprouts, etc. • 2 outbreaks in 2016 – Alfalfa sprouts AND flour • Several each year throughout U.S.

• Symptoms: severe stomach cramps, diarrhea (often bloody), and vomiting (Incubation period usually 3 – 4 days) • Most people recover in 5-7 days – most are very mild with few

cases that are severe and life-threatening • Hemolytic uremic syndrome may result in death in

children under age five

• Treatment: Non-specific supportive therapy – Hydration • Antibiotics have not been shown to be helpful

• Prevention: Consumption of contaminated food, water, and feces of others (including animals)

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Campylobacteriosis

• Caused by a curved, g− bacillus, Campylobacter jejuni • The most frequent cause of bacterial diarrhea in the U.S.

• CDC FoodNet estimates 14 cases per 100,000 persons occur each year

• Symptoms: Diarrhea (bloody), cramping, abdominal pain, fever, nausea and vomiting 2 – 5 days after exposure

• Treatment: Hydration therapy and occasionally antibiotics are prescribed and effective

• Prevention: Simple food handling practices – wash hands and cook food thoroughly

• Poultry, cattle, and unpasteurized milk have been identified as potential sources

• Many isolates are antibiotic resistant

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Listeriosis

• Caused by the g+ bacillus, Listeria monocytogenes

• This organism is distributed worldwide • 1600 illness & 260 deaths in U.S. each year

• Contaminates cold cuts, hot dogs, soft cheeses, etc. – grows under refrigeration

• Symptoms: Fever, muscle aches or stiff neck – blood or spinal fluid will have bacteria

• Prevention: Food safety

• Treatment: Antibiotics • Listeriosis is usually mild in healthy adults and children

• Infants, the elderly, the immunocompromised, and pregnant women are at high risk

• Fetuses and newborns may become acutely ill from their infected mothers

• Antibiotics must be given promptly to prevent infection and miscarriage of a fetus

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Pseudomembranous colitis

• Caused by a g+, spore-forming bacillus, Clostridium difficile

• Transmission is via fecal–oral route

• A major cause of nosocomial infection

• Associated with hospital patients and older adults on antibiotics

• Approximately 500,000 cases in U.S. each year with more than 15,000 deaths

• Depletion of the normal flora by the use of antibiotics may allow C. difficile to “grow out,” usually causing mild to severe diarrhea

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Table 09.02: The Ten Commandments for Reducing the Risk of Foodborne and Waterborne Infection.

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Table 09.01: Foodborne and Waterborne Bacterial Diseases.

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Airborne Bacterial Diseases

The major airborne bacterial diseases are

divided into upper and lower respiratory

tract infections

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Will discuss TB with HIV

Diphtheria

• Caused by an exotoxin produced by the g+ bacillus, Corynebacterium diphtheria

• Kills epithelial cells, which accumulate, forming a leathery pseudomembrane

• Symptoms: weakness, sore throat, fever, swollen glands • Within 2 – 3 days a thick coating can build in nose and

throat

• Death by suffocation may result

• Toxin diffuses into the bloodstream and may cause widespread damage, particularly to the heart

• Treatment: Diphtheria antitoxin to counteract toxin and antibiotics • Kept in isolation to reduce potential spread and vaccination

of all individuals is key to prevention

Figure 09.08A: Inflammation of tonsils.

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Diphtheria

• Diphtheria is rare in the United States and the rest of the developed world • In 1921 – 206,000 cases with 15,520 deaths

• Vaccination campaigns have significantly dropped these numbers – DTaP vaccine • Less than 5 cases in the U.S. in the past decade

• It is a significant problem in the underdeveloped world • WHO recorded 4,887 cases worldwide in 2011.

• Immunization programs are needed to control the disease

• Complications of the disease include: • Blocking of airway

• Damage to heart muscle

• Paralysis

• Lung infections

• Inflammation of nerves

• 1 out of 10 diphtheria patients die – even with treatment.

Courtesy of the CDC 9/19/2017 Ch. 06 - Bacterial Diseases 20

Pertussis – Whooping cough

• Caused by the g− coccobacillus, Bordetella pertussis

• Humans are the only reservoir; there is a particular threat to children under age 4

• Transmission via contaminated droplets (talking, coughing, sneezing, and laughing) – share breathing space

• VERY CONTAGIOUS

• Bacilli bind to ciliated epithelial cells in upper respiratory tract

− Exotoxin damages ciliated cells which function to clear mucus from air passages

− Triggers deep and rapid inspirations causing “whoop”

• Is considered a reemerging disease

• B. pertussis is endemic to the United States

− Epidemics occur every 3-5 years

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Whooping cough

• Symptoms: Develop 5 – 10 days after being exposed typically • Begins with cold-like symptoms – mild cough and fever

• Early symptoms: Runny nose, low-grade fever, mild-occasional cough, apnea (pause in breathing)

• Later symptoms: 1 – 2 weeks of progression include Paroxysms (fits) of rapid coughs followed by high-pitched whoop, vomiting, exhaustion • Coughing fits could last for 100 days

• Treatment: Antibiotics, not cough medicine (won’t help), and manage dehydration

• Prevention: VACCINATION (DTaP) – booster every 10 years, and good hygiene practices

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Streptococcus infections

• A large genus of g+ cocci, the most virulent is S. pyogenes; infections range from mild to deadly

• Streptococci reside naturally in the human nose and throat

• Transmitted by respiratory droplets or contact with sores or wounds

• Streptococcal pharyngitis (tonsillitis) is common in children 5-15

• Long-term complications from repeated childhood strep infections

• Glomerulonephritis, a kidney disease

• Rheumatic fever, a condition involving the heart and joints

• Streptococcal toxic shock syndrome and necrotizing fasciitis are caused by invasive strep that cause life-threatening infections

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Erythrogenic toxin-producing strains of Streptococcus pyogenes causes scarlet fever and a characteristic “strawberry tongue”

Figure 09.10: Streptococcus pyogenes.

Figure 09.11: Characteristic “strawberry tongue” of a patient with scarlet fever.

Courtesy of the CDC

© imagebroker/Alamy Images

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Invasive S. pyogenes can cause the life- threatening necrotizing fasciitis

Figure 09.12: Necrotizing fasciitis.

• Toxins made by the bacteria can cause tissue to die. • Rare (650 to 800 cases annually in the U.S.)

• Not contagious!

• Treatment: antibiotics, skin grafts, amputations, hyperbaric oxygen therapy

• 25% of necrotizing fasciitis is caused by Group A strep

• Other bacteria can cause life-threatening necrotizing fasciitis • Klebsiella

• Clostridium

• E. coli

• Staphylococcus aureus

• Aeromonas hydrophila 9/19/2017 Ch. 06 - Bacterial Diseases 26

Streptococcus infections

• Group A strep infections

• Typically causes mild illness such as strep throat or impetigo (skin infection)

• Severe illnesses range from pneumonia, necrotizing fasciitis, toxic shock syndrome

• Bacteria is inoculated into parts of body where this bacteria is not usually foundStreptococci reside in the human nose and throat

• Prevention: Good hygiene/handwashing practices

• Complete antibiotic regimen

• Group B strep – a primary concern for newborns and infants • Early onset disease: newborns have symptoms at birth

• Late onset disease: newborns appear healthy at birth and develop disease about a week later

• Symptoms: fever, difficulty breathing and feeding, blue-ish skin color, irritableStreptococcal pharyngitis (tonsillitis) is common in children 5-15

• Prevention: Pregnant women testing positive for group B strep

• About 25% of pregnant women carry Group B strep in rectum or vagina and are considered “positive”

• Receive IV antibiotics during labor – not before because bacteria can return

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Meningitis – Bacterial (discuss viral in later section)

• Meningitis is an inflammation of the meninges

• Early diagnosis is essential – Symptoms: cold-like symptoms progress quickly to fever, possibly delirium, and stiffness in the neck and back • 10 – 15% death rate even with treatment, 11 – 19 % of survivors have long-

term disabilities

• The two most common causes are:

• (1) Neisseria meningitidis, a g− diplococcus • 10% of people are carriers of bacteria

• Transmission: Person to person via exchange of respiratory and throat secretions during close contact

• Treatment: Meningococcemia, responds to antibiotic therapy

• College students living in dormitories appear to be particularly susceptible to meningococcal meningitis • Individuals “close” to case receive prophylaxis antibiotics to

prevent potential further spread

• Vaccine recommended for people 10 – 25 years old • Protects against three common serotypes (B, C, and Y)

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Meningitis – Bacterial (discuss viral in later section)

• The two most common causes are:

• (2) Haemophilus influenzae type b (Hib), a g− bacillus

• Hib infections include: • Meningitis

• Bacteremia

• Pneumonia

• Hib meningitis occurs primarily in children under age five

• Incidence has dropped with the Hib vaccine in early 1990s

• Was the #1 cause of bacterial meningitis prior to vaccine

• About 10% of healthy people carry Hib in nose and throat

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Lower Respiratory Tract Infections

Legionnaire's disease (legionellosis) is caused by a g- bacillus, Legionella pneumophila • Nationally reportable disease that causes ~8,000-18,000 hospitalizations

each year in U.S.

• Legionella bacteria found naturally in environment – usually warm water • Transmission: Inhalation of aerosols that come from a contaminated water

source (Cooling towers, hot tubs, hot water tanks, decorative fountains) • NOT PERSON-to-PERSON

• Prevention: Eliminate sources of warm, stagnant contaminated water - aerosolization

• Symptoms: Fever, muscle pain, cough, and pneumonia (all typical of other respiratory infections) • People middle-aged and older, smokers, and those with chronic lung disease are the

most susceptible

• Death is usually by shock and kidney failure (5 – 30% rate)

• Treatment: Antibiotics

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Tularemia (Rabbit Fever)

• A zoonotic disease, is caused by the g− bacillus, Francisella tularensis • Highly virulent; ID is as low as 10 bacilli

• Reservoirs are small mammals (mice, rabbits, squirrels, etc.)

• Transmission: Inhalation of aerosols, contact with infected animals, ingestion of contaminated food or water, and, most commonly, arthropod bites (ticks) • No evidence of person-to-person transmission

• Symptoms: Depends on how bacteria enters body • Ranges from mild to life threatening – all forms have a very high fever…104°

• Ulceroglandular/Glandular

• Oculoglandular

• Oropharyngeal

• Pneumonic – cough, chest pain, difficulty breathing that can cause severe respiratory illness and pneumonia

• Its highly infectious nature and the ease of dissemination by aerosols makes it a potential biological weapon

• Treatment and Prevention: • Difficult to diagnose – Antibiotics for 10 – 21 days

• Vaccine is available only to high-risk groups

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Contact Diseases (Other Than STDs)

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Peptic Ulcers • Ulcers are caused by Helicobacter pylori,

a g−, curved/spiral shaped bacterium • Not stress or diet (spicy food)

• Bacteria produces enzyme urease, which breaks down urea into ammonia and CO2, ammonia neutralizes stomach acid, allowing the bacteria to survive

• Transmission: person-to-person contact (fecal-oral & oral-oral) • Two-thirds of world’s population if infected with H. pylori

• Symptoms: Gnawing/burning pain in the epigastrium, nausea, vomiting and loss of appetite

• Treatment: Infection (and ulcers) can be cured with antibiotics and proton pump inhibitor (alleviate ulcer-related symptoms) • Infection is also associated with gastric cancer

• ~20% of the population under age 40 and 50% over 60 are infected in the U.S.; only ~10% ever get ulcers

• 500,000 – 800,000 cases diagnosed in U.S. each year with 1 million related hospitalizations

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Leprosy – Hansen’s disease • Caused by the bacillus Mycobacterium leprae

• Transmission: Extended skin contact and droplets • Incubation period is long – 2 - 10 years before signs and symptoms appear

• Children are most susceptible

• Disease characterized by a variety of physical manifestations

• Tumor like skin lesions (lepromas)

• Neurological damage to cooler areas of the body, such as the hands, feet, face, and earlobes

• Lost ability to perceive pain in the fingers and toes, results in accidental burns and serious deformities

• Treatment: 6 months – 2 year antibiotic regimen

• Leprosy is rare in U.S. – 95% of adults are naturally unable to have disease

• Disease widespread in parts of Asia, Africa, and South America

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Figure 09.20B: A historic painting of female leper with missing limbs ringing a

bell to announce her presence.

Leprosy is manifested by tumor-like lesions (lepromas) and other physical deformities

Figure 09.20D: Tumorlike lesions due to leprosy.

Figure 09.20E: Leprosy.

© Biomedical Communications/Custom Medical Stock Photo

© 1exposure/Alamy

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Staphylococci

• Bacteria are g+ cocci; normal flora of the skin, mouth, nose, and throat (30% of people naturally care this)

• Unless the skin barrier is broken (by burns or trauma), staphylococci are normally harmless

• Different disease presentation than food-borne illness discussed earlier

• Cause of purulent (pus containing) skin lesions, pimples, boils, carbuncles

• Can progress into systemic (bloodborne) infections

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Staphylococcus aureus

• Most virulent of the staph • Infections can cause – Bacteremia, Pneumonia (usually has other

lung issues…ventilator), Endocarditis, Osteomyelitis (bone infection)

• Methicillin-resistant S. aureus (MRSA), Vancomycin-resistant S. aureus are the leading causes of nosocomial infections in U.S.

• Symptoms/Disease: • Impetigo is a superficial blister that produces an oozing highly infectious

yellow discharge

• Scalded skin syndrome causes blistering skin due to an exfoliative toxin

• Toxic shock syndrome from S. aureus strains that secrete the TSS-exotoxin, eliciting high fever, nausea, vomiting, peeling of the skin (particularly on the palms and the soles), and a dangerous drop in blood pressure that leads to life-threatening shock

• Risk: Anyone can develop staph infection – people at higher risk include diabetes, cancer, vascular disease, eczema, lung disease

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Community-acquired MRSA infections

• 2% of individuals are carriers of MRSA • Associated with…

• Athletic facilities • Highly physical sports

• Dormitories

• Military barracks

• Correctional facilities

• Day care centers

• Prevention: Maintain good hand and body hygiene

• Symptoms: “Spider bite” – bump or infected skin that is red, swollen, painful and warm to touch, fever

• Treatment: healthcare professional drains sight and prescribes antibiotics

Courtesy of CDC 9/19/2017 Ch. 06 - Bacterial Diseases 38

Soilborne Diseases

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Soilborne Diseases Anthrax is caused by Bacillus anthracis,

a g+ endospore-forming bacillus

• Anthrax is primarily found in grazing animals, mostly sheep and cattle; infection most prevalent in agricultural areas

• Anthrax is a likely candidate for use in biowarfare, because these spores can be readily spread by missiles and bombs

• Antibiotics are effective against all forms of anthrax, but early intervention is necessary

• Vaccine is available for high risk workers

• Not effectively transmitted from person-to- person

Figure 09.23A: B. anthracis bacteria and refractile endospores.

Figure 09.23B: B. anthracis mucoid growth on plate.

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Three varieties of anthrax

• There are three varieties of anthrax (can take 1 day to 2 months to appear)

• Inhalation anthrax (woolsorter’s disease) the most severe of the three, is an occupational hazard for humans exposed to contaminated dead animals and animal parts (e.g., tanners and sheep shearers), who are most likely to inhale spores • Symptoms: fever, chills, shortness of breath, cough, nausea, head and body aches

• Cutaneous anthrax is acquired by contact with bacilli or spores via wool, hides, leather, or hair products • Symptoms: small blisters that may itch, swelling around sore, ulcer

• Gastrointestinal anthrax results from ingesting under-cooked meat contaminated with B. anthracis, leading to acute inflammation of the gastrointestinal tract, abdominal pain, vomiting of blood, and severe diarrhea • Symptoms: fever, chills, sore throat, painful swallowing, hoarseness, nausea,

diarrhea, head ache

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Anthrax

• Most common in agricultural regions of Central and South America, sub- Saharan Africa, central and southwestern Asia, southern and eastern Europe, and Carribean

• Rare in U.S. (1 – 2 cases in humans per year) – But sporadic outbreaks occur in wild and domestic grazing animals

• Animals ingest spores in contaminated soil, plants, and water

• Vaccination is recommended in livestock

• People are infected by: • Working with infected animals or products

• Eating raw or undercooked meat

• Injecting heroin – reported in Europe

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Tetanus (lockjaw)

• A non-communicable disease, acquired by exposure to spores of Clostridium tetani, a g+ bacillus

• Tetanospasmin is a neurotoxin; the second most deadly bacterial toxin

• Tetanus bacilli are ubiquitous and are abundant in soil, manure, and dust

• Spores germinate and bacilli multiply in deep, anaerobic, puncture wounds (from gunshot wounds, animal bites, etc.)

• Tetanus prevents muscle relaxation, resulting in uncontrollable contraction Opisthotonos is extreme contractions in the back and rib muscles that cause the body to arch severely

• Death occurs by suffocation Figure 09.25B: Tetanus – opisthotonos.

Courtesy of CDC 9/19/2017 43

Figure 09.25A: Tetanus causing muscle contraction

and rigidity.

Figure 09.25C: Risus sardonicus or facial tetany.

Tetanus

• The number of tetanus cases in the U.S. is about 50 - 100 per year

• Absent or inadequate immunization leads to higher incidence in underdeveloped countries

• VACCINATION IS KEY – DTaP

• Treatment: Medical emergency requiring human tetanus immune globulin, control of muscle spasms, and antibiotics

• Neonatal tetanus is common in the first month of life • The disease is prevalent in poor-nations when an infant is delivered

under unsanitary conditions to a nonimmunized mother (the umbilical cord may be contaminated when cut)

• Prevention is centered on vaccination of all women of childbearing age, improved delivery and post-delivery practices, and education

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Leptospirosis – Swamp fever

• Caused by spirochete Leptospira interrogans • Notifiable disease – 100-200 cases a year (50% occurring in Hawaii)

• Reservoirs are various animals – cattle, pigs, horses, dogs, rodents, wild animals

• Transmission: Spread via urine (But not person-to-person) • Spirochetes penetrate the human skin, enter the bloodstream, and rapidly invade virtually

all organs

• Humans come into contact with water, soil, food contaminated with urine from animals

• May be transmitted by ingesting water contaminated with rat urine

• Symptoms: Mistake for other illnesses…fever, head & muscle ache, chills, vomiting, jaundice, red eyes, diarrhea, rash – First phase of disease

• Second phase – Kidney or liver failure or meningitis

• Treatment and Prevention: Antibiotics – don’t swim in contaminated water and use protective clothing in contaminated locations

• Leptospirosis is most common in tropical countries 9/19/2017 Ch. 06 - Bacterial Diseases 45