세균성 위장염

Bacterial gastroenteritis occurs when pathogenic bacteria, commonly Escherichia coli strains, are ingested through contaminated food or water. The infection causes inflammation of the stomach and intestines, leading to characteristic symptoms including diarrhea, abdominal cramps, and vomiting. Undercooked meat, unpasteurized dairy, raw vegetables, and contaminated water are frequent sources of infection.

Shiga toxin, produced by enterohemorrhagic E. coli strains, enters intestinal epithelial cells and blocks protein synthesis by cleaving adenine bases from ribosomal RNA. This toxin action results in cell death and damages intestinal blood vessels, causing bloody diarrhea. The toxin's B subunit binds to host cell receptors, initiating uptake and transport to the cytosol where the A1 subunit exerts its damaging effect.

Enteropathogenic E. coli use a Type III secretion system to inject bacterial proteins directly into host intestinal cells. These injected effectors trigger the host cell to reorganize its surface, forming pedestal structures that lock the bacterium in place. This process destroys microvilli and impairs nutrient absorption, resulting in watery diarrhea and reduced intestinal function.

Genes encoding Shiga toxins are not native to the E. coli chromosome but are carried by lysogenic bacteriophages—viruses integrated into bacterial genomes. This phage-mediated horizontal gene transfer allows non-toxigenic E. coli strains to acquire toxin-producing capability, enabling the emergence of new pathogenic variants. This genetic exchange mechanism contributes significantly to the evolution of dangerous bacterial strains.

Genomic classification frameworks identify critical virulence markers including the LEE pathogenicity island, which encodes the Type III secretion system, and the co-occurrence of stx and eae genes. These markers distinguish Shiga toxin-producing E. coli from other pathotypes. The presence of these genetic elements helps predict bacterial virulence and disease severity in clinical and epidemiological contexts.

Shiga toxin damages vascular endothelial cells in the intestines, leading to bloody diarrhea and potentially hemolytic uremic syndrome—a severe complication affecting red blood cells and kidney function. The toxin's mechanism of blocking protein synthesis in blood vessel cells compromises vessel integrity. This vascular damage represents one of the most serious complications of Shiga toxin-producing E. coli infection.

Type III secretion system effectors, such as Tir, are injected into intestinal epithelial cells where they induce actin reorganization. This reorganization causes the host cell to form pedestal structures beneath adherent bacteria and efface microvilli. The resulting loss of microvilli reduces the intestinal surface area available for nutrient absorption, contributing to malabsorption and watery diarrhea characteristic of enteropathogenic E. coli infection. Similar bacterial infection mechanisms occur in bacterial meningitis.