بسم الله الرحمن الرحيم 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 thin, 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 /F /M /F /F /M /M

بسم الله الرحمن الرحيم GENUS: HELICOBACTER Prof. Khalifa Sifaw Ghenghesh

Spiral, curved/straight G-ve rods. Motile. Microaerophilic / 37 o C. Oxidase +ve > 15 species of Helicobater –H. pylori

Helicobacter pylori 3D morphology

Helicobacter pylori showing typical thin, comma- or S-shaped forms (72 h culture).

1. 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.