13: campylo

8/10/2019 13: Campylo

1/5

Transcribed by Tina Park 12.2.14

Infectious Disease Lecture 13 Campylobacter , Helicobacter, Cholera by Dr. Hanna

(Dr. Hanna was absent so Dr. Boylan gave an introduction to his lecture on the three bacteria.)

[Dr. Boylan] Im waiting for our guest lecturer to appear. Dr. Bruce Hanna. I forgot to send a

reminder, but usually he doesnt need a reminder to come. So lets give him a few more minutes.

Hes supposed to be here again tomorrow afternoon so if he doesnt come today he will finish up

most of what he had today and tomorrow afternoon. Dr. Hanna will bring you nothing but the best

for this course. He was for many years Director of Clinical Microbiology and Immunology at

Bellevue Hospital. He sort of had Dr. Tiernos position. Dr. Tiernos position at Tisch Hospital, now

Langone Medical Center. Dr. Hanna had that same position at Bellevue for many years. And he is a

proud father of two recent graduates of NYU College of Dentistry. So maybe if you were figuring

what they are doing. When he appears today or tomorrow. He lives uptown, east seventy second

street. So maybe he got caught in traffic.

But the topics for today, Campylobacter, Helicobacter, and Cholera, Let me say a few words about

them in case he doesnt show up. So when he does talk about them he can go through them a littlemore rapidly. Campylobacter jejuni,of course you dont have slides up yet, the lecture has not yet

appeared. Keep an eye out, maybe they will show up a little later. Caught in traffic I hope.

Campylobacter jejuni.

Campylobacter jejuni. Helicobacter pylori, and Vibrio cholereae. Campylobacter jejuni.What is

important to know about that is it is a gram negative, a curve rod. It is a bacterium that is ordinarily

found in farm animals. It infects your GI tract. It causes a zoonosis in humans. Meat contaminated

meat. Mostly chicken or beef. But campylobacter, one thing you have to remember about it, is an

infection called Campylobacteriosis. And it is the most common food borne infection in the United

States today. More so than Salmonella, Shigella, and even E. coli. Campylobacter jejuni.So farm

animals. Zoonosis.

And actually one of the most prevalent populations of people who get sick with this type of food

poisoning, Campylobacteriosis, are your age group. Students who are in their early twenties or go

away to college, or go into dental school, away from home for their first time. And go okay I am tired

of spending all this money, going out, eating at diners or getting pizza all the time, Im going to start

cooking for myself. So often what happens is these students they get a hot plate that they are not

supposed to have in their resident halls. They sneak that in. Im going to have a chicken dinner. So

they go out and they go buy a big chicken at a supermarket. And sometimes they are contaminatedwith fecal matter from the chicken that had not been thoroughly cleaned at the market or along the

way they get to your table or you havent washed it thoroughly. And you have all this bacteria there.

And you can come down with this infection. What happened was okay I will get this whole chicken

and I will put it on the hot plate. And I will turn on the hot plate real high and wait to hear all this

crackling, sizzling, and blackening of this skin. Then I will turn him over and do the same on the

other side and then Ill eat it. But that is not good enough. It doesnt kill all the bacteria around the

chicken. So you have to thoroughly heat the meat, chicken poultry, or whatever you eat before you

8/10/2019 13: Campylo

2/5


eat it in order to kill the bacteria already there. So this is why it is a more prevalent infection in the

young twenties primarily. But everybody is susceptible to it. One of those food borne infections that

come from animals. Zoonosis.

What else about Campylobacter? Oh yes. One of the qualities of this particular infection is something

known as the Guillain-Barr syndrome. Hopefully that is on your notes as well. It is a neurologicalproblem that people have after certain infections. Maybe days or even week later. Where they have

a nervous tick or nervous disorder. They are kind of on edge. It is a neuroglogical thing. Guillain-

Barr syndrome. And it comes upon this. I can think of one other. The flu which is a common

complication of particular infections. This is a bacterial infection of course. Flu being a viral

infection. But right around a certain people get this Guillain-Barr syndrome. He might mention

something about this tomorrow. He has to go through these list slides tomorrow rapidly. There are

some symptoms. Really he has a lot of slides. I know he has a lot of slides. As a clinical

microbiologist we like to tell you every single thing that is possibly known about these bacteria. I

try to condense a little bit. Try to pick out what is most important. What are the most important

diagnostic tests for these bacteria we are talking about or are there certain treatments that are

unusual but designed for just these infections. I will talk about the next one in this group of bacteria.

So curve. Got negative rod. It is also known as a microaerophil. The Campylobacter jejuni. A

microaerophil. Meaning it quickly grows well with reduced oxygen tension. We are right now

breathing in air that is 20% oxygen concentration. Most of what we are breathing nitrogen. Most

bacteria will grow in the environment we are in. We put this bacteria in a plate, test tube, or

incubator they will go well. But these bacteria, the Campylobacterare in particular microaerophils.

For a long time we didnt know about them. People were getting sick. We couldnt culture any

bacteria from feces from people with diarrhea, from gastroenteritis. Until someone said, lets

reduce oxygen tension from 20% to about 5% so we have ways to do that. We have these

incubators that can reduce oxygen tension in the same way we can reduce CO2 tension inside theincubators. We can reduce from 5% to 20%. Within these microaerophils, the Campylobacter

flourish. They grow well. We can identify them by the colonies on certain media. He will talk about

that.

Helicobacter pylori

Another one of those, the Helicobacter pylori. Also a curve gram negative rod. It has a similar

appearance to Campylobacter. This has a very interesting history I believe. This is the one that

causes peptic ulcers. This is bacterium responsible for a majority of stomach ulcers. Even

duodenum. I remember when I was a kid. One of my brothers friends who was very brilliant

throughout elementary and high school at least. And he was always coming up with ulcers. He

pushed himself to a certain extent and was put under stress all the time. He had these ulcers, eating

away at the lining of his stomach. Now we know with his case and for others as well. Bacterial

infection and the bacteria caused peptic ulcers and duodenum ulcers as well. Helicobacterflagellum.

Curved rod with a single flagellum. The reason they know this. Well the fellow who discovered that

this was the case that this bacterium caused peptic ulcers. He was one of those scientists who was

8/10/2019 13: Campylo

3/5


scoffed at. Bacteria dontcause ulcers. Stress and other environmental factors, maybe chemicals,

maybe they cause ulcers. And you die. But not bacteria.

So he was onto this belief. And he was and Australian physician., a pathologist actually. He was

trying to find a similar animal study to do these studies to prove that Helicobacter pylori caused

ulcers. He couldnt find one. Hamsters, mice, rats. They could not play host to this bacterium. Sowhat was the only guinea pig he could use? Himself. Humans. So his name was Marshall. He was

from Australia once again. He decided he wants to show once and for all that this bacterium was

suspecting to cause ulcers. He did it to himself once again as the guinea pig. So what he did was first

he had his stomach lining inspected with an endoscope. Someone looked at it. Everything was fine.

No ulcers. No problem with the stomach tissues at all. Subsequently he took a test tube full of these

bacteria, Helicobacter pylori. To prove what he wanted to prove. I can see him standing there with

this tube full. I dont know the concentration but quite a large number. And I was thinking what did

he say? What would his people in the lab say when he was about to do this because it was a pretty

important study. If it turned out right and it did. He would say something like this is one small step

for man and one large step for mankind like Neil Armstrong said, or something like that. All he said

was, well here goes. And he swallowed it. And what did his lab mates say? They just said youre

crazy. Youre nuts.

But anyhow, he swallowed these bacteria. And a few hours later he heard gurgling and rumbling

from his gut and feeling not too well. And after a day or two of this, maybe a couple days., he did get

this gastroenteritis. Okay lets see what this lining looks like now. So back down with this

endoscope. Inspect the lining of the stomach. And saw aha! There was destruction of the lining of

his stomach. Looked down there. Picked out some samples and sure enough when streaked these

samples on a petri plate. They found the bacteria they grew. And Helicobacter pyloriwas like Kochs

principles, Kochs Postulates, that is. They used the same bacteria. Isolated them. Put it back in the

environment in the stomach and then re-isolated them after he got sick. That is what I like abouthim. Most Noble Prize winners these days getting awarded on work in molecular biology and

physiology, immunology and all this great stuff. He got the Noble Prize. This Marshall did about 10

or so years ago for his discovery that Helicobacter pylorifor causing peptic ulcers and actually can

lead to cancer as well over a long term if you harbor these bacteria in your stomach for a long time.

And it is kind of neat. How these bacteria survive in that low pH, in the acidity of the stomach. Most

bacteria dont. Most are destroyed as they pass through the stomach.

For a matter of fact, the next bacteria I am going to talk about for a little bit. Cholera you actually

need millions of bacteria to either eat or drink for them to cause cholera in you because they are

just so sensitive to low pH. This bacteria have some neat tricks to be able to survive in the stomach.

One of them is they produce an enzyme called urease. This is the enzyme that breaks down urea. Sothese bacteria that are growing there and when they fuse this enzyme, urease, it breaks apart uric

acid and forms ammonia. Ammonia is one of the products when urea is broken down. And ammonia

brings the pH up a bit. So these bacteria are in the acidic environment of the stomach but they are

surrounded by a cloud of alkaline pH due to the ammonia when they break down uric acid. That is

one of the virulence factors. Another one. They have the flagellum to help them burrow down into

stomach. Helps them to stick to tissue in stomach. Couple of virulence factors. Once again it is the

8/10/2019 13: Campylo

4/5


virulence factors they it has that enable them to have this particular disease. Not just one bacterium

that doesnt cause all infections. Different bacteria that have different virulence factors that it can

happen in an environment such as this. By protecting themselves from the environment. And in this

case producing an ammonium cloud around them to help them survive. And know also there is an

unusual treatment for this particular infection. Sometimes it is 1-2 antibiotics. Plus something that

might protect your stomach. Plus proton inhibitor. So I think he will talk about that later tomorrowthat has more than just one type. Two or three. It varies. It used to be one. Pepto-Bismol used to be

one. Now Im not sure what he has down. Check for it. This is an unusual treatment for this

particular infection.

Vibrio choleae

Lets see what else. The third one I dont have much to say about that. Vibrio choleae, the Cholera

bacterium. Also a curved rod. A singular polar flagellum. It is one of the few bacteria that scared

people. You hear about cholera epidemic or cholera outbreak. Choleraplague or dysentery even orsmall pox over the ages. You hear about Cholera. This bacteria has a number of unusual features in

that it has caused a number of pandemics over the past century. And it has the ability to grow in

water. Both salt water and regular water. It can grow in oceans and lakes and streams. Most

bacteria cannot grow well in both types of water. Ocean and freshwater as well but this bacteria can

and it can survive and it grows well if it finds enough nutrients in the water to grow on.

Right now in Haiti there is an outbreak of Cholera. And it was from some UN workers. They came to

Haiti to help with some of the flooding a couple years ago. But they came, these UN people, and set

up an establishment, some sort of housing for themselves on top of the hills. Then more rain came.

They didnt take care of keeping their sewage away from the other streams that flow down into the

villages below. So some of these people from other countries, UN people, healthcare workers hadcholera and they spread it this way. The rain came. Streams brought Choleradown. There were

terrible, terrible outbreaks and many deaths from it. It is really a terrible infection. I read about

some books recently about people who die from cholera. It is agonizing terrible way to go because

they become completely dehydrated. Those can be very serious. GI disturbances. Diarrhea.

Gastroenteritis infections. They can be very serious when you lose a lot of water and electrolytes

that come from tissues that are being broken apart. Releasing electrolytes and salts. These

particular toxins bacteria is producing is called choleragin. And it acts the same way that the E. Coli,

LT exotoxin works. If you remember the LT, remember the E. Colithe toxigenic strain. The etec E.

coli.Some produced in the LT toxin of this xt toxin (?). LT being the heat-labile toxin. And as you

may recall that is the one e coli when they produce it. From tissues. From gut. They produce thistoxin LT. Adenocyclase to convert ATP into cyclic AMP. The increases, we dont need much cyclic

AMP in our cells to survive. Very few quantities. But if the levels go up of cAMP in our cells, this is

what happens in all of our cells of our guts during the infection of E. coli LT toxin produced. You

lose water. Thats where all this water comes from. And you lose water from these cells. Cells of our

body, our intestine. And all the salts leave as well. Other E. coli maybe they can prevent the

absorption of water. But LT we lose water from our own cells.

8/10/2019 13: Campylo

5/5


So the toxin, cholerabacteria, is called choleragin. Once again it works the same as LT. and it is

much more potent than the LT toxin of E. coli.It is the same thing but you lose about a liter of fluid

every hour of Cholera. That is about 24 liters a day, 24 quarts of water you lose a day. So you get

lose of water, you get cells that are sloughing off. There are clumps of bacteria, clumps of cells. And

it leads to a condition known as Rice Water Stools very watery, buckets of water with specs of

bacteria cells debri. So they are referred to this particular sign known as Rice Water Stools.

He will probably talk about a couple different. One of particular type, Second serial type of Cholera

seems to be spreading throughout the world and as with any of these infections being two that are

gastroenteritis are from the best therapy. Not necessary an antibiotic because once they are there

doing this thing in your body doing this type of damage, you want to replace the fluid and the

electrolytes that are being lost. So you want to use something like for kids Pedialyte or Gatorade or

things like that. So fluid replacement therapy. Or oral rehydration is often better. Replace those

fluids. Keep the person comfortable and at the least try to get them to absorb as mucha so you can

the salts in the water that is in Pedialyte or in Gatorade. And I should say another one of these

things these solutions such as Pedialyte. What they do in parts of Africa. They have packets. Packet

of powder with these salts. And actually they often use, they add one sugar. Should remember two.

So these salts like sodium chloride, calcium chloride, magnesium etc ammonium sulfite, all these

things that are necessary and they should also have some sort of glucose in it as well. And you get

these packets that is kind of like Tang. I dont know if you have Tang anymore. Or just add even

dehydrated coffee. You just add that to water to solubalize it.. you can find somewhere in this

country where there are these outbreaks of cholera to find an area with clean water and you just

add these things and replenish the fluids and the salts. Glucose is there to help ourselves to absorb

the electrolytes. Help the absorption of these salts in the solutions that I use for therapy.

Anything else? Campylobacter, Helicobacter. Those are some of the more important things. Im sure

he has a lot more to say about them. I didnt send him a reminder this time to him to come. But I

certainly will tonight. He is supposed to back tomorrow afternoon for a couple hours of lecture. Any

questions about those three? (Laughter.) I didnt even bring my computer today. Im sure there are

some other important... I think if... Try to distinguish these infections in that way what is unique

about them. Those are the most important things. Such as the therapy used for Helicobacter pylori.

Anything unusual. Now, remember that. Okay Ill call him and well see you tomorrow.

13: campylo

Documents