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Digestive Diseases Shigellosis Staphylococcus aureus food intoxication Cholera Shigellosis (Bacillary Dysentery) An acute intestinal disease caused by the bacterium Shigella Dysentery means diarrhea with abdominal cramping The term bacillary dysentery is reserved for infection by the four species of Shigella: S. dysenteriae, S. flexneri, S. boydii, and S. sonnei Shigellosis contiued Endemic in North America, Europe, and the tropics Infection is more common in children ages 1-4 years and in the elderly , debilitated and malnourished The only reservoir for Shigella organism is the human intestinal tract, and infected feces are always the source of the infection Incubation period is usually 1 to 3 days Transmission Directly by fecal-oral route transmission or indirectly through contact with contaminated objects. Widest distribution of the organism is through contaminated water or food Transmission occurs primarily through individual who fail to wash their hands or clean their fingernails after defecation Food can also be contaminated by flies that carry enough of the organism for it to multiply to an infectious dose in food When dogs ingest human feces, the infection can be passed by them to children or other susceptible persons Symptoms Shigellae invade the intestinal mucosa and cause inflammation In children: usually produces diarrhea, high fever, nausea, vomiting, abdominal pain with distention, irritability, and drowsiness Pus, mucus, and blood may appear in stools as a result of the intestinal ulceration (typical of this infection) In adults: produces many of the same symptoms except that adults generally do not have fever Treatment Persons with mild infections usually recover quickly without antibiotic treatment Many strains of Shigella are resistant to antibiotics If an effective one can be found, then the shigellae can be eliminated quickly When many persons in a community are affected by shigellosis, antibiotics are sometimes used to treat only the most severe cases The antibiotics commonly used for treatment are ampicillin, trimethoprim/sulfamethoxazole (also known as Bactrim* or Septra*), ceftriaxone (Rocephin*), or, among adults, ciprofloxacin Some antidiarrheal drugs can make the illness worse and should be avoided Prevention No vaccine at present Control of the human reservoir and sanitary control of environmental sources through: Adequate treatment of water and sewage, fly control and protection of food, water, and milk from human or mechanical vectors Staphylococcus aureus Food Intoxication Staphylococcus Aureus Food Intoxication One of the most common causes of foodborne illness in the U.S. and the world S. aureus is a natural inhabitant of the human body and is also responsible for boils and other infections Occasionally, the reservoir may also be cow with infected udders Most persons are susceptible to this kind of foodborne illness Short lasting and rarely fatal Transmission The illness is caused by ingesting food in which staphylococci have been multiplying and producing toxin Staphylococci grow in many foods, especially pre-cooked hams, milk, custards, cream fillings, and salad dressings Source of food contamination is usually a person with an infected lesion on the hands, arms, and face Foods implicated in staphylococcal outbreaks reported to CDC during a 5 year period Meat (ham, pork, beef) 15% 38% 10% Multiple sources, unknown Vegetables and fuits Shellfish 10% 20% 3% 2% 2% Dairy (milk, cheese, butter) Poultry Symptoms The interval between eating the food and the onset of symptoms may be as little as 30 minutes or as long as 7 hours Usually the incubation period is 2-4 hrs. Abrupt and sometimes violent onset, which helps to disntinguish it from other types of foodborne illness Nausea, vomiting, cramps, and diarrhea are the typical symptoms Loss of fluid and violent vomiting may lead to prostration, lowgrade fever, and lowered blood pressure Treatment Not necessary unless the individual becomes dehydrated If dehydration occurs: oral rehydration in extreme cases: Intravenous (IV) therapy may be used to replace fluids Prevention Time from preparation of food to serving needs to be as short as possible Proper heating or cooling procedures need to be followed Any individual with boils, or other infected lesions on hands, face, or nose should be prohibited from food handling Food handlers and others should be educated about food hygiene, sanitation and cleanliness Cholera Cholera Acute gastrointestinal infections caused by Vibrio cholerae Caused by an exotoxin produced by the organism Most likely to be found and spread in places with inadequate water treatment, poor sanitation, and inadequate. Humans are the only know reservoir, although there is a possibility of environmental reservoirs Transmission Transmitted through feces or vomitus of carriers or persons with active infections Epidemic spread usually results from contaminated water supplies Food is involved more often in sporadic cases in endemic areas Hands, utensils, clothing, and flies may contaminate food or carry the infection directly to the mouth Symptoms Infection is often mild or without symptoms, but can sometimes be severe Incubation period is generally 2-3 days Communicability lasts as long as the stools are positive , usually only a few days after recovery White flecks appear in the stools as they increase (“rice water stools”) Due to massive loss of fluid, other symptoms occur: Thirst, weakness, sunken eyes, muscle cramps, and cardiovascular problems Collapse, shock, and death may follow if the patient is not continuously rehydrated until the infection subsides Treatment Electrolyte solution must be given immediately and continuously to replace lost fluids Mild cases Oral fluid replacement is adequate Tetracycline and other antibiotics are used if symptoms persist Effective in reducing duration and volume of diarrhea Speeds the elimination of the bacteria from the feces Prevention Proper sanitation and vaccine are the best methods of prevention Currently, there are two oral cholera vaccines available People traveling to epidemic areas in other countries may be required to have a vaccination Control methods are the same as they are for other diseases acquired through the alimentary route