3D-PH Group 5 Members: Rosvielentine Rosales 40 Katrina Taracatac Deric Vengua INTRODUCTION Diarrhea Diarrhea is the passage of 3 or more

loose or liquid stools per day, or more frequently than is normal for the individual. World Health Organization intestinal disorder abnormal frequency and fluidity of fecal evacuations may be life threatening (young children and people who are malnourished or have impaired immunity) 44 47 PharCare

Escherichia coli (E. coli) I. Theodor Escherich (1885) Gram-negative, facultative anaerobic, rod-shaped bacterium commonly found in the lower intestine of warm-blooded organisms (endotherms) some strains are harmless (part of the normal flora of the gut, and can benefit their hosts by producing vitamin K 2, and by preventing the establishment of pathogenic bacteria within the intestine) can have the ability to cause disease of the gastrointestinal, urinary, or central nervous system occasionally responsible for product recalls due to food contamination

DEFINITION E. coli Diarrheal Disease an intestinal disorder characterized by an increased frequency of liquid bowel which is caused by the bacteria Escherichia coli classified on the basis of serological characteristics and virulence properties: ETEC - Enterotoxigenic E. coli EPEC - Enteropathogenic E. coli EIEC - Enteroinvasive E. coli EHEC - Enterohemorrhagic E. coli EAEC - Enteroaggregative E. coli

TYPE ETEC (Enterotoxigenic E. coli) EPEC (Enteropathogenic E. coli) EIEC (Enteroinvasive E. coli)

EPIDEMIOLOGY Food, water Young children in & travellers to developing countries Person-to-person Young children & neonates in developing countries Food, water Children in & travellers to developing countries Food All ages but most common in children & elderly Food, water

HOST found humans, pigs, sheep, goats, cattle, dogs, and horses found in humans, rabbits, dogs, cats and horses

CLINICAL SYNDROME *Travellers diarrhea

**Watery diarrhea

found only in humans

***Dysentery

EHEC (Enterohemorrhagic E. coli) EAEC (Enteroaggregative E. coli)

found in humans, cattle, and goats

Dysentery (Hemorrhagic colitis, hemolytic-uremic syndrome) Travellers diarrhea, acute diarrhea, ****persistent diarrhea

Children in & travellers to developing countries; all ages, industrialized countries

found only in humans

* Travellers diarrhea - the most common illness that affects travellers. It affects people travelling from developed countries to developing regions of the world. ** Watery diarrhea - lasts several hours or days *** Dysentery acute bloody diarrhea **** Persistent diarrhea lasts for 14 days or longer

II.

SYNONYMS Travellers diarrhea Loose bowel movement (LBM) Irritable bowel syndrome (IBS)

III.

MODE OF TRANSMISSION Fecal Oral route humans may act as a vehicle for the spread of the bacteria (person-to-person) poor hygiene ingestion of water contaminated with human feces consumption of contaminated food contaminated through water, soil, flies and through human mishandling

IV-VI.

E. Coli Strains Enterotoxigenic E. Coli (ETEC)

Enteropathogenic E. Coli (EPEC) Enteroaggregative E. Coli (EAEC)

Defining Molecular Trait - Enterotoxin Heat Stable Heat Labile - Cholera like (mechanism) - Attaching/ Effacing Lesion Aggregative/ Diffused Adherence Mucus biofilm stacked-brick pattern O157:H7 Attaching/ Effacing Lesion Shiga Toxin Cell to cell Invasion Dysentery like (mechanism)

Clinical syndrome Watery Diarrhea

Invasiveness - Non invasive

Incubation Period - 12-72 hours

Watery Diarrhea Watery Diarrhea Acute, Persistent Diarrhea

Moderately Invasive Noninvasive

1-2 days 20- 48 hours

Enterohemorrhagic E. Coli (EHEC)

Enteroinvasive E. Coli (EIEC)

Bloody Diarrhea Hemorrhagic Colitis Hemolytic Uremic Syndrome Bloody Diarrhea (Dysentery)

Invasive

3-4 days

Invasive

1-3 days

VII. Laboratory/Diagnostic Tests and Results SMAC (Sorbitol MacConkey agar)- Almost all e coli strains are positive while the EHEC (O157:H7) being the only one testing negative EMB (Eosin Methylene Blue agar) Test for lactose fermentation; Green metallic sheen (+) usually for all e.coli infections except EHEC. Serotyping identification of the antigen code of a particular strain HEp-2 adherence assay- Test for adherence to HEp-2 cells; EAEC and EPEC infections will test positive Enzyme immunoassay (EIA) - An assay that uses an enzyme-bound antibody to detect antigen. Polymerase Chain Reaction (PCR) - is a relatively simple and inexpensive tool that you can use to focus in on a segment of DNA and copy it billions of times over.

VIII. Treatment Rehydration (oral rehydration therapy or intravenous in severe cases) Avoid anti-motility drugs; the toxins could be reabsorbed if not eliminated Blood Transfusion and Dialysis because of anemia and renal failure from Hemolytic Uremic Syndrome Antibiotics: - Trimethoprim-Sulfamethoxazole (Co-Trimoxazole) Most commonly used for e. coli infections; side effect is Steven Johnsons Syndrome - Fluoroquinolones (Ciprofloxacin, Ofloxacin) Side effect is Arthropathy - Gentamicin Ototoxic - Azithromycin - Rifaximin

IX. Preventive Measures Cook meat to a temperature of at least 71 C Prevent cross contamination ( Washing of hands, utensils, cutting boards, counters) Avoid unpasteurized milk Wash and peel raw fruits and vegetables

Avoid street foods Assurance of the safety of drinking water (boiling and purifying)