lecture 20-campylobacter and helicobacter

الرحيم الرحمن الله الرحيم بسم الرحمن الله بسم

GENUS: CAMPYLOBACTER

Prof. Khalifa Sifaw Ghenghesh

•Slender, Helically Curved Rods.

•Corkscrew-Darting Motility.•Oxidase: +ve •Microaerophilic >–Campy. jejuni–Campy. coli–Campy. lari (Campy. laridis)–Campy. Fetus

•Arcobacter >> A. butzleri

Campylobacter fetus Leifson flagella stain

Campylobacter jejuni

Campylobacter jejuni

Campylobacter jejunithin, comma-, S-, or gull-winged shaped forms

(48 h culture)

VIRULENCE FACTORS

•Motility•Adherence• Invasion•Toxin Production–Cytotoxins:–Enterotoxins

DISEASE

• in Animal:• in Man:

– Diarroeal Illness: – Guillain-Barre Syndrome (GBS):

LABORATORY DIAGNOSIS

• Specimen:

• Culture:– Selective media >> Skirrow's >

• Incubation: – Temp.– microaerobic gas generation packs

• Identification:– Oxidase, Gram stain, Hippurate hydrolysis

Blood agar plate culture of Campylobacter fetus s. intestinalis

TREATMENT

• Campylobacter enteritis– Self-limiting– Fluid and electrolyte replacement

• Erythromycin• Fluoroquinolones

– Ciprofloxacin

EPIDEMIOLOGY

• Incidence• Source of Transmission

– Poultry and Raw Meats– Other routes of Infection

• Education:– Keep food that will be eaten raw, such as vegetables, from

becoming contaminated by raw animal-derived food products. – Thoroughly cook all food products from animals, especially

poultry, and avoid consuming unpasteurized milk, or other unpasteurized products.

– Cases should not prepare food for other individuals or attend child care until diarrhea has resolved.

– Educate case and household contacts on proper hand washing techniques.

– Always wash hands thoroughly with soap and water before eating or preparing food, after using the toilet, after changing diapers, and after touching pets or other animals (especially puppies and kittens with diarrhea).

– After changing diapers, wash your hands AND the child’s hands.

– In a childcare setting, dispose of stool and soiled diapers in a sanitary manner.

CONTROL

• Food Handlers:

– Food handlers should be excluded from work until diarrhea has resolved.

– While individual circumstances may vary, cases are generally not required to provide two negative stools to return to work.

– If a case has questionable hygienic practices or there are other concerns, a food handler should be excluded from work until two negative stool cultures have been obtained at least 24 hours apart.

– In an outbreak situation, negative cultures may be required to return to food handling.

CONTROL

Information on children with Campylobacter-associated diarrhoea in Tripoli.________________________________________________Pt. Age/ Stool with Vomiting Fever

dehyd- Sex mucus blood

ration---------------------------------------------------------------------------------1. 3/F -- + -- -- +2. 7/M -- -- + + --3. 8/F + -- -- -- --4. 9/F -- -- -- -- +5. 4/M + -- + -- --6. 14/M + -- -- + -----------------------------------------------------------------------------------

بسم الله الرحمن بسم الله الرحمن الرحيمالرحيم

GENUS: HELICOBACTER

Prof. Khalifa Sifaw Ghenghesh

•Spiral, curved/straight G-ve rods.

•Motile.•Microaerophilic / 37oC.•Oxidase +ve•> 15 species of Helicobater–H. pylori

Helicobacter pyloriHelicobacter pylori3D morphology3D morphology

Helicobacter pylori showing typical thin, comma- or S-shaped

forms (72 h culture).

1. H. pylori1. H. pylori

•Natural Habitat:- Human gastric mucosa.- Dental plaque.- Human faeces.

•Transmission:- Faecal-oral or Oral-oral route.- Flies ???

•Virulence Factors:–Urease, Phospholipase A, etc.

•Clinical Significance:–Duodenal Ulcer & Gastritis.–Gastric adenocarcinoma.

LABORATORY DIAGNOSIS

1. Invasive Tests:– Specimen:Gastric mucosa.– Microscopy:– Culture: Selective media– Biopsy urease test:

2. Non-Invasive Tests:– Serology: Abs to HP – Urease breath test:

TREATMENT

Twice-Daily PPI-Based Triple Therapies• Cure rate 90%: 2 weeks (? 10 days) in U.S., 1 week

outside U.S.• Omeprazole 20 mg bid or Lansoprazole 30 mg bid • Clarithromycin 500 mg bid • Amoxicillin 1 g bid or Metronidazole 500 mg bid

Twice-Daily RBC-Based Triple Therapy• Cure rate 90% in 2 weeks• Ranitidine bismuth citrate 400 mg bid • Clarithromycin 500 mg bid

• Amoxicillin 1 g bid (?metronidazole 500 mg bid)

FDA-Approved (USA) Dual Therapies

• Cure rate 70% at 2 weeks

• Omeprazole 40 mg qd

• Clarithromycin 500 mg tid

• Cure rate 80% at 2 weeks

• Ranitidine bismuth citrate 400 mg bid

• Clarithromycin 500 mg tid

H. cinaedi H. fennelliae

• Natural Habitat:– Intestinal tract in rodents.– Human faeces & rectal cultures.

• Clinical significance:– Proctocolitis, Proctitis, Enteritis,

Bacteraemia.