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Transcript
GASTROINTESTINAL TIC BORNE INFECTIONS Martin D. Fried, MD, FAAP Pediatric Gastroenterology Physician Nutrition Specialist 3200 Sunset Ave Suite 100 Ocean, NJ 07712 Gastrointestinal Complaints abdominal pain vomiting blood in stool constipation heartburn chest pain soiling diarrhea mouth sores MULTISYSTEM difficult swallow Skin rashes Apthous Ulcers Canker Sore Erythema Nodosum Psoriasis Ulcers Colitis Rectal Fissure Skin Tag vs Granuloma Psoriasis with Granuloma Bartonella Borrelia burgdorferi H pylori Mycoplasma Salmonella, EBV Clostridium difficile SINGLE INFECTIONS 30 6 Lyme 3 Bartonella 9 12 Helicobacter Mycoplasma COINFECTIONS = 20 Lyme Bartonella Mycoplasma 6 10 2 TRIPLE INFECTIONS = 6 4 LYME 2 BARTONELLA MYCOPLASMA HELICOBACTER 80 PATIENTS, 88 INFECTIONS 35 30 25 20 15 10 5 0 BART MYCO HELICO LYME Bartonella henselae Heartburn, Abdominal Pain, Skin Rash, Gastritis, and Duodenitis • • • • • • Cat Scratch Fever Lymphandenopathy hepatitis-elevated liver enzymes Splenitis Pneumonitis Fever Unknown Origin Gastrointestinal Bartonella • Hepatosplenic Abscess • Abdominal Pain-burning • Mesenteric Adenitis-mimic Appendix GI Presentation • • • • Heartburn Abdominal Pain Skin Rash-striae –stretch marks Enlarged Lymph nodes VIOLACEOUS RASH NEW BLOOD VESSELS GI Infections • tic bite • No prior GI complaints • No steroid use • No abrupt weight gain Infection and or Diet • Pain not resolved by antacids, Histamine blockers, PPI Skin Rash Violaceous- deep reddish purple Serpinginous- “snake like” Breast or lower back Groin or back knee Periumbilical (belly button) Inner thigh stretch marks are different Mesenteric Adenitis • CT Abdomen • Lymph Nodes > 1cm in diameter • May mimic appendicitis Endoscopy and Biopsy • Assess the GI mucosa – H. pylori – Bartonella by PCR – Borellia burgdorferi PCR – Mycoplasma PCR – Ehrlichia and Babesia PCR Bartonella Pathology • • • • Chronic Gastritis and or duodenitis No Ulcer No evidence of allergy (eos) No Acute Inflammation (polys) Bartonella Rashes • • • • • Maculopapular Urticarial Erythema Nodosum (crohns also) Granuloma Annulaire (ringworm) Thrombocytopenic Purpura • Leukoclastic Vasculitis Striae • Endothelial Proliferation • Differentiate from stretch marks • in obese or steroid using patients Bartonella GI Inflammation • An Association Shown • IL-2, IL-6, IL-10, Elicited Interleuken 6 • Multipotent cytokine • Elicited by Infections • Induces inflammation NEOVASCULARIZATION NEW BLOOD VESSELS STEROID EFFECT STEROID EFFECT SERPINGINOUS RASH = INFECTION SNAKE LIKE = INFECTION Helicobacter pylori Bacteria Infects humans only Transmitted - human to human H. pylori • • • • Irritant to stomach lining Cause of gastric, duodenal ulcers Lifelong infection unless treated Predispose to stomach cancer due to chronic irritation Helicobacter pylori Nodularity Gastritis Eradication of H. pylori Two antibiotics for two weeks Clarithromycin Amoxacillin Proton pump inhibitor for a month intracellular death of infection Mycoplasma • • • • Intracellular infection Rarely in the blood Worsens Lyme, Bartonella symptoms Fibromyalgia, CFS, RA, and Gulf War Mycoplasma protein • Stimulates immune cells • Proinflammatory cytokines TNFalpha, IL-1, IL-6 • GI may resemble Crohn’s Chronicity of Mycoplasma • Surface antigenic variation • Supress host immune responses • Slow growth rates • Intracellular locations • Can take 3 years to eradicate • Can follow IgM and IgG titers Celiac vs Food Intolerance • Celiac is Autoimmune to wheat, rye, barley • Gluten, Genetics and Environment • Intolerance is IgE or non IgE mediated Inflammation causes permeable gut Foreign proteins to immune system Crohn’s, Colitis, Celiac Treatment complications Candida Albicans Candida Albicans • Normal Flora Yeast • Antibiotics kills Normal Flora • Yeast overgrowth occurs • Diet to produce lactobacillus, bifidobacteria • Short chained fructooligosaccharides (FOS) • Not a casein or gluten related problem Clostridium difficile • C. difficile is normal bacterial flora • Antibiotics kill lactobacilli, bifidobacter • C. difficile overgrowth occurs • C. difficile elicits – Toxin A and Toxin B • Pseudomembranous colits • Treat with Metronidazole and probiotics • However, prebiotics help L and B multiply Pseudomembranous Colitis Foods with sc FOS • Banana onions • garlic asparagus • Barley wheat • Tomatoes leeks Conclusions • Lyme, Bartonella, Mycoplasma occur in the GI tract of children 5-21 yrs • PCR biopsies to document infection • Consider Coinfections • Prevent yeast, c. difficile overgrowth with prebiotics and probiotics
