1. Asiatic or Epidemic Cholera
Vibrio cholerae
Asiatic or Epidemic Cholera

2. Readings Question #1
Describe the Vibrio cholerae bacterium. Where is it found?

3. Outbreaks no major outbreaks in U.S. since 1911 sporadic: 1973-1991
1991: South America – Peru
1,099,882 cases and 10,453 deaths ( )
1992: new strain – Bangladesh and India
1 case in U.S.

4. Symptoms of Cholera “rice-water” stools viscous blood
sudden onset, incubation: 6 hrs- 5 days
violent vomiting
No fever
abdominal cramps, nausea, dehydration, shock
1 million organisms

5. Progression of Disease

6. Diagnosis isolated from feces recovered from foods
pathogenic and non-pathogenic forms exist
test for presence of cholera enterotoxin

7. Treatment of Cholera water and electrolyte replacement tetracycline
oral rehydration therapy
sodium chloride, sodium bicarbonate, potassium chloride and dextrose
intravenous rehydration
tetracycline
untreated – 50% mortality rate
death occurs from dehydration and loss of essential electrolytes

8. Bacillus anthracis 1877 isolated by Robert Koch Readings question #2:
List 5 characteristics of the Bacillus anthracis bacterium.

9. People at Risk handle animals, hides, wool, and other animal products
goat hair and handicrafts containing animal hides from the Middle East
infection initiated by endospores
2 exotoxins: edema toxin and lethal toxin
capsule does not stimulate a protective response

10. Readings Question #3
What are the 3 forms of anthrax that affect humans?

11. Treatment of Anthrax antibiotics ciprofloxacin and doxycycline
preventive doses of antibiotics (60 days)
vaccination of livestock
live attenuated
human vaccine: inactivated form
6 injections over 18 months
Annual boosters

12. Diagnosis of Anthrax
isolation and identification from a clinical speciman

13. Biological Weapons “the use of living pathogens for hostile purposes”
14th century: 1346 Tartar army at Kaffa
began the plague pandemic for
1925: 100 countries
Sino-Japanese War ( )
canisters of fleas carrying Yersinia pestis dropped on China

14. U.S. Epidemic Intelligence Service
formed in 1951 (after start of Korean War)
early warning system
important role in combating epidemics and tracking outbreaks of disease
1940s-1960s: research on biological weapons
develop vaccines or treatments

15. “Operation Sea-Spray”
September 27 and 27, 1950
Serratia marcescens over San Francisco and Florida (Panama City and Key West)
non-pathogenic, reddish coloration
September 29: 11 patients (1 died)
Pneumonia
January 2008: recall of pre-filled heparin-lock flush solution

16. Serratia marcescens production of red pigment
damp conditions: bathrooms
complete eradication is difficult
dirt, “sterile places”, biofilm of teeth
hospital settings: catheters, saline irrigation solutions, sterile solutions
urinary and respiratory tract infections in hospitals
conjunctivitis, keratitis, endophthalmitis, tear duct infections
resistant to several antibiotics

17. Biological Weapons 1972: 100 countries
1979: Bacillus anthracis in Sverdlovsk
explosion resulting in 100 deaths in 2 weeks
1984: The Dalles, Oregon
Salmonella enterica
2001: U.S. Postal Service
Bacillus anthracis
“bioterrorism”

18. Bordetella Whooping Cough (Pertussis)
2 basic toxins: 1) tracheal cytotoxin
- damages ciliated cells
2) pertussis toxin
- systemic symptoms
small children: violence of coughing can break ribs
infants: irreversible damage to the brain occasionally occurs
adults: misdiagnosed as bronchitis

19. Diagnosis of Pertussis
clinical signs and symptoms
throat swab culture
culture on special media
rapid tests available

20. Treatment of Pertussis
Erythromycin
Antibiotics render the patient noninfectious
Immunity following recovery is good
DTap Vaccine: 1996, minimal side effects
lowered annual cases
fewer than 10 deaths/year
effectiveness wanes after 12 years of age
elderly and infants

21. Enterics (Enterobacteriaceae)
Genera: Escherichia, Klebsiella, Proteus, Salmonella, Shigella
straight rods, simple nutritional requirements
intestinal tracts of humans and animals
fermenters of glucose and carbohydrates
fimbriae
sex pili
proteins: lysis of closely related species

22. Readings Question #4
What is the most significant opportunistic pathogen of all the enterics? Where is it found?
traveler’s diarrhea

23. Klebsiella pneumoniae
normal flora of mouth and skin
naturally occurs in soil
new antibiotic resistant strains
nosocomial infection: invasive treatments

24. Pathogenesis bacterial pneumonia severe, rapid onset
high fever, chills, flu-like symptoms, cough
“currant jelly” sputum
mortality fairly high
lung destruction and abcesses
empyema
bronchitis
urinary tract and wound infections
feces and contaminated instruments

25. Treatment resistant to penicillin and its derivitives
two or more powerful antibiotics
susceptible to aminoglycosides and cephalosporins
culture: sputum, blood, and urine samples
and swab of surgical site

26. Proteus Hospitals: colonizes skin and oral mucosa
Rod-shaped, gram-negative bacilli
Soil, stagnant and standing water, fecal matter, raw meats, dust
Proteus mirabilis: 90% (community-acquired)
highly motile, does not form regular colonies

27. Proteus “Swarming Colonies”

28. Pathophysiology Fimbriae attach to uroepithelial cells
bloodstream: sepsis
Long-term indwelling urethral catheters
UTIs most common clinical manifestation
Readings question #5:
What is the significance of Proteus vulgaris to the embalmer?

29. Salmonella all members potentially pathogenic
biochemical and serological tests
common inhabitants of the intestinal tract of many animals, especially poultry and cattle
contaminate food: unsanitary conditions
gram-negative, facultatively anaerobic, non-endospore-forming rods

30. Salmonella enteritidis
intestinal mucosa
lymphatic and cardiovascular system
less than 1% mortality rate
normal recovery in a few days
shed in feces for up to 6 months
40-50,000 reported cases; 2-4 million cases
Sources: intestinal tracts of animals
1 in 20,000 eggs
pet reptiles (90%)

31. Treatment
antibiotic therapy is not useful
oral rehydration therapy

32. Shigella facultatively anaerobic gram-negative rods pathogenic E. coli
many cases of “traveler's diarrhea” may actually be mild forms of shigellosis
small infective dose
primary site: large intestine
toxins, destroy tissue, dysentery
rarely invade the bloodstream
diagnosis: rectal swabs
fluoroquinolones

33. Yersinia pestis Scratches and bites from domestic cats
Flea bite – bloodstream- lymph and blood
Survive and proliferate in phagocytic cells
Fever
“buboes”

34. “Septicemic Plague” septic shock
“pneumonic plague”: 100% mortality rate
spread by airborne droplets
diagnosis: isolating bacterium
treatment: streptomycin, tetracycline
recovery confers reliable immunity
vaccine