ORAL AND GASTROINTESTINAL DISEASES CHAPTER 22 Copyright © 2012 John Wiley & Sons, Inc. All rights reserved.

Anatomy Review Mouth Stomach Hepatobiliary tree Small Intestine Large Intestine © 2012 John Wiley & Sons, Inc. All rights reserved.

Bacterial Oral Cavity Disease Dental Plaque Accumulations of dextrans (biofilm) May calcify Dental Caries Streptococcus mutans Lactic acid erodes dental enamel Periodontal disease Tooth support structures Gingivitis – gum inflammation Periodontitis – root of tooth also affected © 2012 John Wiley & Sons, Inc. All rights reserved.

Viral / Fungal Oral Cavity Disease Mumps – Paramyxovirus URT and salivary glands are affected Resurgence recently due to complacency and failure to vaccinate Complications – male sterility, meningitis, eye, ear infections, attack on other exocrine/ endocrine glands Thrush © 2012 John Wiley & Sons, Inc. All rights reserved.

Bacterial Gastrointestinal Intoxications Staphylococcal Enterotoxicosis Staphylococcus aureus High starch or cream content, high protein foods Foods subjected to temperature abuse Cooked foods need to be covered/refrigerated to avoid bacterial growth and toxin production Toxin can survive 30 minutes of boiling Low mortality Diarrhea symptoms 1-8 hr after food consumption © 2012 John Wiley & Sons, Inc. All rights reserved.

Other Enteric Intoxications Clostridium perfringens Enterotoxicosis Casseroles Anaerobic bacterium Toxin produced during endospore formation Diarrhea 8-24 hr after food consumption Self-limiting *Also causes gas gangrene, see Nervous System diseases © 2012 John Wiley & Sons, Inc. All rights reserved.

Enteric Intoxications Botulism (Clostridium botulinum) Consumed toxin can cause flaccid paralysis Life support needed to prevent suffocation Bacillus cereus Food poisoning associated with rice/ meat contamination Found in water and soil Pseudomonas cocovenenans Polynesian coconut contamination Food poisoning may be fatal © 2012 John Wiley & Sons, Inc. All rights reserved.

Infections - Terminology Enteritis Inflammation of the intestine Physical damage Invasion of cells by bacteria Dysentery Submucosal damage leads to blood and mucus in the stool Gram negative bacteria may cause fever to accompany symptoms © 2012 John Wiley & Sons, Inc. All rights reserved.

Bacterial Gastrointestinal Infections Salmonellosis Salmonella enteritidis serotype Poultry and poultry products 2000 strains Notifiable disease Strains help to trace public health problems to their source Diarrhea 8-24 hr after food consumption Self limiting, low mortality in infants and elderly © 2012 John Wiley & Sons, Inc. All rights reserved.

Bacterial Infections – Typhoid Fever Salmonella typhi Human reservoir only Fever headache diarrhea Many organs invaded Bact. in urine, blood, feces WBC count decreases Less than 500 cases/yr in U.S.A. Fluoroquinolones, chloramphenicol Good public health measures prevent transmission © 2012 John Wiley & Sons, Inc. All rights reserved.

Bacterial Shigellosis Shigella dysenteriae and others Primates are a reservoir Contaminated water assists spread 10 bacteria may be enough to cause diarrheal disease 450,000 cases/yr in U.S.A. Symptoms for 2-7 days, self limiting Day care center transmission © 2012 John Wiley & Sons, Inc. All rights reserved.

Bacterial - Asiatic Cholera Vibrio cholerae Developing nations Rice water stool Death due to shock/fluid loss Rehydration therapy may be more effective than antibiotics © 2012 John Wiley & Sons, Inc. All rights reserved.

Bacterial Gastrointestinal Infections Vibriosis Vibrio parahemolyticus Seafood associated Marine bacteria, may also infect wounds Self limiting 2-5 days Traveler’s Diarrhea Escherichia coli is a common pathogen Water sources Dehydration is biggest danger Complications – infectious IBS , lactose intolerance © 2012 John Wiley & Sons, Inc. All rights reserved.

Enterohemorrhagic E. coli E. coli O157:H7 Shiga toxins cause intestinal hemorrhage, kidney failure, blindness Children most sensitive Ground beef, uncooked produce 3000 cases/yr estimated, 30 deaths in U.S.A. © 2012 John Wiley & Sons, Inc. All rights reserved.

Campylobacter Enteritis Campylobacter jejuni Food/H2O borne, copious diarrhea Opportunistic Second only to Salmonella in incidence Animal intestines are source Fluid replacement most important © 2012 John Wiley & Sons, Inc. All rights reserved.

Bacterial Stomach Infections Peptic Ulcer/Chronic Gastritis Helicobacter pylori Neutralizes stomach acid by degrading urea 4 million sufferers in U.S.A. Treatment Antibiotics Acid suppressors Stomach “liners”, e.g. Pepto Bismol © 2012 John Wiley & Sons, Inc. All rights reserved.

© 2012 John Wiley & Sons, Inc. All rights reserved.

Clostridium difficile Diseases Pseudomembranous colitis Diarrhea Clostridium difficile Endospore former Common after long-term antibiotics Difficult to eradicate Nosocomial pathogen © 2012 John Wiley & Sons, Inc. All rights reserved.

Viral GI Diseases Viral Enteritis Rotavirus Common in children Enterovirus Norwalk virus (norovirus) Hepatitis Liver inflammation © 2012 John Wiley & Sons, Inc. All rights reserved.

Hepatitis Types HAV Hepatitis A (HAV) RNA virus Oral-fecal transmission Family transmission or contaminated water/shellfish 15 – 40 day incubation Jaundice, fever, malaise, nausea, diarrhea, abdominal pain, anorexia 50% of cases asymptomatic Self-limiting, immunity is gained Vaccine since 1995 © 2012 John Wiley & Sons, Inc. All rights reserved.

Hepatitis B (HBV) Double stranded DNA virus Blood to blood transmission Sexual Intravenous drug route/ transfusions Semen and breast milk Symptoms as for HAV but liver cell damage is occurring Vaccine recommended for all health care workers since 1986 Also recommended for infants (90% will become chronic carriers) Carrier status linked to cirrhosis and liver cancer in later life © 2012 John Wiley & Sons, Inc. All rights reserved.

Hepatitis Types Hepatitis C (HCV) Blood borne like HBV More temperature resistant Casual transmission Hepatits D (HDV) Requires co-infection with HBV © 2012 John Wiley & Sons, Inc. All rights reserved.

Protozoan GI Diseases Giardiasis Giardia lamblia Backpackers disease Dysentery from drinking unpurified water Endemic in mountain areas Amebiasis Entameba histolytica Endemic in developing nations © 2012 John Wiley & Sons, Inc. All rights reserved.

Protozoan GI Diseases Balantidiasis Balantidium coli Endemic in developing nations Cryptosporidiosis Cryptosporidium parvum Cows and humans AIDS patients Cyclosporiasis Cyclospora cayentanensis Soft berries Imports © 2012 John Wiley & Sons, Inc. All rights reserved.