Chapter 32 : How Many Bacteria Does It Take To Cause Diarrhea and Why?

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Diarrheal disease is one of the most common diseases of humans. The causative agents of infectious diarrhea and dysentery can be viral, bacterial, or protozoal. Ideally, subjects in a volunteer study should be representative of the population in which diarrheal disease occurs. However, some enteric pathogens, such as rotavirus and enteropathogenic (EPEC), cause diarrhea primarily in infants and small children. Pathogens which are transmitted almost exclusively through the ingestion of common food are believed to require a higher infective dose to produce disease than organisms capable of spreading directly from person to person. This is because food-borne pathogens have often had the opportunity to replicate to high concentrations in foods before consumption. Both volunteer studies and epidemiological data concur in assigning a low infective dose to and diarrhea. Evidence is particularly strong in the case of species, in which numerous volunteer studies with three different species have shown that the infective dose for shigellosis is between 10 and 500 organisms. Most of the enteric pathogens which require a very large inoculum to cause disease, such as and enterotoxigenic (ETEC), are extracellular pathogens whose mode of virulence involves adherence and toxin secretion. The abilities of organisms to survive passage through the normally acidic stomach is probably an important factor for determining infective dose, but other, more specific determinants such as the ability to survive and replicate within cells are likely to play significant roles as well.

Citation: Small P. 1994. How Many Bacteria Does It Take To Cause Diarrhea and Why?, p 479-489. In Miller V, Kaper J, Portnoy D, Isberg R (ed), Molecular Genetics of Bacterial Pathogenesis. ASM Press, Washington, DC. doi: 10.1128/9781555818340.ch32
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Table 1

Infective doses of enteric pathogens required to cause disease on the basis of volunteer studies

The inoculum was administered with or following the ingestion of sodium bicarbonate.

Citation: Small P. 1994. How Many Bacteria Does It Take To Cause Diarrhea and Why?, p 479-489. In Miller V, Kaper J, Portnoy D, Isberg R (ed), Molecular Genetics of Bacterial Pathogenesis. ASM Press, Washington, DC. doi: 10.1128/9781555818340.ch32

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