GASTROINTESTINAL
TIC BORNE INFECTIONS
Martin D. Fried, MD, FAAP
Pediatric Gastroenterology
Physician Nutrition Specialist
3200 Sunset Ave Suite 100
Ocean, NJ 07712
Gastrointestinal Complaints
abdominal pain
vomiting
blood in stool
constipation
heartburn
chest pain
soiling
diarrhea
mouth sores
MULTISYSTEM
difficult swallow
Skin rashes
Apthous Ulcers
Canker Sore
Erythema Nodosum
Psoriasis
Ulcers
Colitis
Rectal Fissure
Skin Tag vs Granuloma
Psoriasis with Granuloma
Bartonella
Borrelia burgdorferi
H pylori
Mycoplasma
Salmonella, EBV
Clostridium difficile
SINGLE INFECTIONS 30
6
Lyme
3
Bartonella
9
12
Helicobacter
Mycoplasma
COINFECTIONS = 20
Lyme
Bartonella
Mycoplasma
6
10
2
TRIPLE INFECTIONS = 6
4
LYME
2
BARTONELLA
MYCOPLASMA
HELICOBACTER
80 PATIENTS, 88 INFECTIONS
35
30
25
20
15
10
5
0
BART
MYCO
HELICO
LYME
Bartonella henselae
Heartburn, Abdominal Pain,
Skin Rash,
Gastritis, and Duodenitis
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•
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Cat Scratch Fever
Lymphandenopathy
hepatitis-elevated liver enzymes
Splenitis
Pneumonitis
Fever Unknown Origin
Gastrointestinal Bartonella
• Hepatosplenic Abscess
• Abdominal Pain-burning
• Mesenteric Adenitis-mimic Appendix
GI Presentation
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•
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Heartburn
Abdominal Pain
Skin Rash-striae –stretch marks
Enlarged Lymph nodes
VIOLACEOUS RASH
NEW BLOOD VESSELS
GI Infections
• tic bite
• No prior GI complaints
• No steroid use
• No abrupt weight gain
Infection and or Diet
• Pain not resolved by antacids,
Histamine blockers, PPI
Skin Rash
Violaceous- deep reddish purple
Serpinginous- “snake like”
Breast or lower back
Groin or back knee
Periumbilical (belly button)
Inner thigh
stretch marks are different
Mesenteric Adenitis
• CT Abdomen
• Lymph Nodes > 1cm in diameter
• May mimic appendicitis
Endoscopy and Biopsy
• Assess the GI mucosa
– H. pylori
– Bartonella by PCR
– Borellia burgdorferi PCR
– Mycoplasma PCR
– Ehrlichia and Babesia PCR
Bartonella Pathology
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•
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Chronic Gastritis and or duodenitis
No Ulcer
No evidence of allergy (eos)
No Acute Inflammation (polys)
Bartonella Rashes
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•
•
•
•
Maculopapular
Urticarial
Erythema Nodosum (crohns also)
Granuloma Annulaire (ringworm)
Thrombocytopenic Purpura
• Leukoclastic Vasculitis
Striae
• Endothelial Proliferation
• Differentiate from stretch marks
• in obese or steroid using patients
Bartonella
GI Inflammation
• An Association Shown
• IL-2, IL-6, IL-10, Elicited
Interleuken 6
• Multipotent cytokine
• Elicited by Infections
• Induces inflammation
NEOVASCULARIZATION
NEW BLOOD VESSELS
STEROID EFFECT
STEROID EFFECT
SERPINGINOUS RASH = INFECTION
SNAKE LIKE = INFECTION
Helicobacter pylori
Bacteria
Infects humans only
Transmitted - human to human
H. pylori
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Irritant to stomach lining
Cause of gastric, duodenal ulcers
Lifelong infection unless treated
Predispose to stomach cancer
due to chronic irritation
Helicobacter pylori
Nodularity
Gastritis
Eradication of H. pylori
Two antibiotics for two weeks
Clarithromycin
Amoxacillin
Proton pump inhibitor for a month
intracellular death of infection
Mycoplasma
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Intracellular infection
Rarely in the blood
Worsens Lyme, Bartonella symptoms
Fibromyalgia, CFS, RA, and Gulf War
Mycoplasma protein
• Stimulates immune cells
• Proinflammatory cytokines
TNFalpha, IL-1, IL-6
• GI may resemble Crohn’s
Chronicity of Mycoplasma
• Surface antigenic variation
• Supress host immune responses
• Slow growth rates
• Intracellular locations
• Can take 3 years to eradicate
• Can follow IgM and IgG titers
Celiac vs Food Intolerance
• Celiac is Autoimmune to wheat, rye, barley
• Gluten, Genetics and Environment
• Intolerance is IgE or non IgE mediated
Inflammation causes
permeable gut
Foreign proteins to
immune system
Crohn’s, Colitis, Celiac
Treatment complications
Candida Albicans
Candida Albicans
• Normal Flora Yeast
• Antibiotics kills Normal Flora
• Yeast overgrowth occurs
• Diet to produce lactobacillus, bifidobacteria
• Short chained fructooligosaccharides (FOS)
• Not a casein or gluten related problem
Clostridium difficile
• C. difficile is normal bacterial flora
• Antibiotics kill lactobacilli, bifidobacter
• C. difficile overgrowth occurs
• C. difficile elicits – Toxin A and Toxin B
• Pseudomembranous colits
• Treat with Metronidazole and probiotics
• However, prebiotics help L and B multiply
Pseudomembranous Colitis
Foods with sc FOS
• Banana
onions
• garlic
asparagus
• Barley
wheat
• Tomatoes
leeks
Conclusions
• Lyme, Bartonella, Mycoplasma occur in
the GI tract of children 5-21 yrs
• PCR biopsies to document infection
• Consider Coinfections
• Prevent yeast, c. difficile overgrowth
with prebiotics and probiotics