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Enterobacteria rod shaped, gram negative.

. Discovered by Theobald Smith w/ Daniel Salmon Many serotypes, main ones of interest: s. enteritidis, s. typhi, s. paratyphi Symptoms : Diarrhoea, vomiting, fever ~1/52 (typhoid/paratyphoid epistaxis, fever, bradycardia, delirium, other complications) Mode of transmission: Mainly via foodstuff insufficiently cooked food or contamination of cooked food. Person to person spread faeco-oral route. Contact with infected animals Incubation period : 12-72 hours

Diagnosis made via blood or stool culture. Treatment generally supportive rehydration, with antibiotics (amoxicillin, ciprofloxacin). Complications most commonly reactive arthritis. With typhoid/paratyphoid encephalitis, intestinal haemorrhage/perforation, abcesses, disseminated infection. Mortality rate: Typhoid fever treated: 1-4% Typhoid fever untreated 10-30% Salmonellosis - <1% Vaccine available for s.typhi (polysaccharide and live attenuated)

Salmonella by serotype (2010) Most common serotype s. enteritidis


4500 4000 3500 3000 2500 2000 1500 1000 500 0 Salmonella by Serotype S.enteritidis S. typhimurium Typhoidal salmonellas Other salmonellas

Salmonella rates by age (2010) Most common in children <1 year of age
90 80 70 60 50 40 30 20 10 0 Salmonella Rates by Age (per 100,000) <1 year 1-4 5-9 10-14 15-44 45-64 65-74 75+

Salmonella cases reported by region (2009) All serotypes included


2000 1800 1600 1400 1200 1000 800 600 400 200 0 Salmonella by reporting region East Midlands East London Northeast Northwest Southeast Southwest West Midlands Wales York & Hum

Rod shaped, gram negative. Closely assoc. e. coli. Discovered 1898 - K. Shiga
Main serogroups of interest: shigella sonnei, s. flexneri, s.boydii, s.dysenteriae Symptoms : Watery diarrhoea followed by bloody diarrhoea Mode of transmission: Mainly faecooral contamination route as well as foodstuff/water. Houseflies. Incubation period : 1-7 days

Diagnosis made via stool culture. Treatment generally supportive rehydration, with antibiotics (amoxicillin, ciprofloxacin). Complications most commonly reactive arthritis. Rarely seizures in children. WHO estimate: 90 million episodes worldwide with 108 000 deaths annually. Vaccine currently under development, mainly for s. flexneri and s. sonnei.

Shigella by serogroup reported faecal isolates (2010)

42 85

Shigella by serogroup

496
1123

S. sonnei S. flexneri S. boydii S. dysenteriae

Rod-shaped bacteria, gram negative. Harmless strains of e.coli usually part of normal gut flora. Discovered 1885 by Theodor Escherich.
Pathogenic strains of e.coli commonly O157, O104, O121, O26, O45, O145. Classified by virulence properties ETEC, EPEC, VTEC. Symptoms : Diarrhoea/bloody diarrhoea. Most common pathogen for UTIs. Serotype with K1 antigen causes neonatal meningitis. Mode of transmission: Faecal-oral route usually ingestion of improperly cooked or contaminated food. Incubation period : 1-10 days

Diagnosis made via culture/microscopy. Treatment antibiotics depending on strain and resistance. Complications VTEC most commonly assoc. haemolytic uraemic syndrome and thrombotic thrombocytopaenic purpura approx 10% develop HUS. ETEC most common cause of travellers diarrhoea approx 200 million diarrhoea episodes and 170,000 deaths annually. VTEC mortality rate in cases associated with HUS : 210% ETEC vaccines available for at-risk travellers

E.coli O157 cases by region (2011)

91 83 163 151 Regional totals 92 74 87 56 0 50 100 150 200 250 193

Wales West Midlands Southwest Southeast Northwest Northeast London East England East Midlands

Corkscrew, gram negative. Campylobacter sp. - mainly c. jejuni and c.coli Symptoms : Diarrhoea, myalgia Mode of transmission: Ingestion of contaminated or undercooked foodstuff (esp. poultry). Faeco-oral route person to person or contact with infected animals Incubation period : 2-5 days usually

Diagnosis made via stool culture. Treatment generally supportive rehydration, with antibiotics (erythromycin). Complications c. jejuni assoc. haemolytic uraemic syndrome & thrombotic thrombocytopaenic purpura. Also causes autoimmune-associated demyelination polyneuropathy of lower limbs, i.e. Guillian-Barre syndrome. WHO estimated 400 million cases worldwide annually. No vaccine currently available immunity appears to be complex and strain-specific.

Campylobacter by age group (2011)


Campylobacter by age group
5416 4363 1695 1500 0-4 5-9 years 10-14 years 15-44 45-64 65-74 75+

7717

23855 19949

Campylobacter by region (2011)

12000 10000 8000 6000 4000 2000 0 Campylobacter by region

East England East Midlands London North East North West South East South West West Midlands Wales Yorkshire & Humberside

Cryptosporidium protozoan parasite in small intestine Sp. of note c. parvum and c.hominis Symptoms : Diarrhoea (may be chronic in immunocompromised) Mode of transmission: Contact with infected animals. May be transmitted through food/water (inc. swimming pools). Person to person spread. Incubation period : Average 7-10 days however can reach 28 days.

Diagnosis made via stool microscopy or PCR Treatment generally supportive rehydration Complications rarely pancreatitis. May cause chronic and severe diarrhoea in immunocompromised : malabsorption and dehydration. No vaccine currently available still in development

Cryptosporidium by month (2011)


Lab reports
400 350 300 250 200 150 100 50 0 Lab reports

Flagellated protozoan parasite giardia lamblia Symptoms : Diarrhoea, abdominal cramps Mode of transmission: Person to person contact, faecooral. Ingestion of contaminated water/food Incubation period : 5-25 days

Diagnosis made via stool microscopy/ELISA. Treatment generally supportive and self-resolves rehydration, with antibiotics if required (metronidazole). Complications damage to the intestinal epithelial cells lactose intolerance/B12 malabsorption
763 608 533 354 279 219 154 42 Giardia cases by region 543 East Midlands East London Northeast Northwest Southeast Southwest West Midlands Wales Yorkshire and Humberside

900 800

700
600 500 400 300 200 100

309

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