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Infectious > Acute Infectious Diarrhea > Flashcards

Acute Infectious Diarrhea Flashcards

1
Q

Is the second most common infectious cause of death among children < 5 yrs old. (Harrison pp 852)

A

Diarrhea

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2
Q

Recurrent Intestinal infections are associated with the following: (Harrison pp 852)

A

Physical and Mental stunting
Wasting
Micronutrient deficiencies
Malnutrition

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3
Q

What are the pathogenic mechanisms involved in diarrhea? (Harrison pp 852)

A

Inoculum size
Adherence
Toxin production
Invasion

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4
Q

In non-inflammatory causes of acute diarrhea, which part of the intestine is involved? (Harrison pp 852)

A

Proximal small bowel

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5
Q

Non-inflammatory causes of acute diarrhea (Harrison pp 852)

A 
Vibrio cholerae
Enterotoxigenic E. Coli
Enteroaggregative E. Coli
Clostridium perfringes 
Bacillus cereus
Staphylococcus aureus
Aeromonas hydrophilia
Rotaviras, norovirus
Giardia lamblia
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6
Q

What is the stool findings in inflammatory cause of acute diarrhea? (Harrison pp 852)

A

Fecal polymorphonuclear leukocytes

INCREASE in fecal lactoferrin

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7
Q

What is the stool findings in non-inflammatory cause of acute diarrhea? (Harrison pp 852)

A

No fecal leukocytes

No or mild increase in lactoferrin

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8
Q

Enterohemorrhagic E. coli causes what disease? (Harrison pp 852)

A

Hemorrhagic colitis

Hemolytic uremic syndrome

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9
Q

Enterotoxin acts directly on _____ in the intestinal mucosa (Harrison pp 852)

A

Secretory mechanism

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10
Q

It is a toxin production that causes destruction of mucosal cells and associated inflammatory diarrhea (Harrison pp 853)

A

Cytotoxins

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11
Q

Acts directly on the central and peripheral nervous system (Harrison pp 853)

A

Neurotoxins

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12
Q

It is a heterodimeric protein (1 unit A, 5 units B) and prototypical enterotoxin (Harrison pp 853)

A

Cholera toxins

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13
Q

It is a syndrome characterized by fever, headache, relative bradycardia and abdominal pain, splenomegaly and leukopenia. (Harrison pp 853)

A

Enteric Fever

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14
Q

Common practices that increases the risk of enteric colonization (Harrison pp 853)

A

Antacids
Proton pump inhibitors
H2 blockers

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15
Q

It is the major mechanism for clearance of bacteria from the proximal small intestines (Harrison pp 853)

A

Normal peristalsis

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16
Q

It is the 1st line defense against many gastrointestinal pathogens. (Harrison pp 853)

A

Mucosal immune system

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17
Q

Blood type O show increased susceptibility to the following bacteria: (Harrison pp 853)

A 
E. coli VS Norovirus
E. coli O157
Vibrio cholerae
Shigella 
Norovirus
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18
Q

Signs of MILD dehydration (Harrison pp 853)

A 
Thirst 
Dry mouth 
Decreased axillary sweat
Decreased urine output 
Slight weight loss
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19
Q

Signs of MODERATE dehydration (Harrison pp 853)

A

SOS
Skin tenting
Orthostatic fall in blood pressure
Sunken eyes

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20
Q

Signs of SEVERE dehydration (Harrsion pp 853)

A 
Lethargy
Obtundation 
Feeble pulse 
Hypotension 
Frank shock
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21
Q

How many weeks should be counted as chronic? (Harrison pp 854)

A

> 2 weeks

22
Q

When is advisable to obtain stools for parasites? (Harrison pp 854)

A

> 10 days

23
Q

Bloody stools WITHOUT fecal leuckocytes (Harrison pp 854)

A

Enterohemorrhagic Escherichia Coli

24
Q

Painful rectal spasms with a strong urge to defecate but little passage of stools (Harrison pp 854)

A

Tenesmus

25
Q

It is a marker of fecal leukocytes and more sensitive and available in latex agglutination (Harrison pp 854)

A

Fecal lactoferrin

26
Q

Post - diarrhea complications (Harrison pp 855)

A 
Chronic diarrhea (Lactase deficiency, Small bowel bacterial overgrowth, Malabsorption)
IBS
Reactive Arthritis
Hemolytic Uremic Syndrome
Gullain Barre Syndome
27
Q

What compromise Hemolytic Uremic Syndrome?(Harrison pp 855)

A

Hemolytic Anemia
Thrombocytopenia
Renal Failure

28
Q

What organisms involved in Reactive arthritis? (Harrison pp 855)

A

Shigella
Salmonella
Campylobacter
Yersinia

29
Q

It is the most common travel-related infectious illness (Harrsion pp 855)

A

Traveler’s diarrhea

30
Q

It is the most common etiologic agent associated with outbreaks of acute gastroenteritis. (Harrison pp 855)

A

Norovirus

31
Q

It is identified as cause of antibiotic associated hemorrhagic colitis. (Harrison pp 855)

A

Klebsiella oxytoca

32
Q

It is the major cause of dysentery (Harrison pp 855)

A

Shigella

33
Q

It is the emerging enteric pathogen with worldwide distribution (Harrison pp 855)

A

Enteroaggregative E. coli

34
Q

It affects the hikers and campers (Harrison pp 855)

A

Giardia lambia

35
Q

Bacteria that is resistant to chlorine treatment (Harrison pp 855)

A

Cryptosporidium

36
Q

They are particularly at risk of C. difficile colitis and Giardiasis. (Harrison pp 855)

A

Hypogammaglobulinemia

37
Q

It is commonly found at fried rice. (Harrison pp 856)

A

Bacillus aureus

38
Q

It is found in egg salad, dairy products (mayonnaise) and poultry (Harrison pp 856)

A 
Staphylococcus aureus (1-6 hrs of incubations)
Salmonella spp. (> 16 hours of incubations)
39
Q

It caused abdominal cramps and found in legumes and gravies (Harrison pp 856)

A

Clostridium perfringens (8-16 hrs of incubations)

40
Q

It is found in Mollusks and crustaceans (Harrison pp 856)

A

Vibrio parahaemolyticus (> 16 hrs)

41
Q

Bacillus cereus can produce short incubation and also long incubation syndrome. What are those two types of form? (Harrison pp 856)

A

Emetic form

Diarrheal form

42
Q

What culture should be used in Cholera? (Harrison pp 856)

A

Thiosulfate-citrate-bile-salts-sucrose agar or Tellurite -taurocholate-gelatin (TTG) agar

43
Q

True or False: All patient with fever and evidence of inflammatory disease acquired outside the hospital should have stool cultured for Salmonella, Shigella and Campylobacter. (Harrison pp 856)

A

True

44
Q

What is the main stay treatment for diarrhea? (Harrison pp 856)

A

Adequate hydration

45
Q

What is “Reduced-osmolality/reduced salt” that is recommended by the WHO? (Harrison pp 856)

A
  1. 6g (3.5): Sodium chloride
  2. 9g: Trisodium citrate/ Na Bicarbonate
  3. 5 g: Potassium chloride
  4. 5g (20g): Glucose
46
Q

Suggested therapy for watery diarrhea without distressing enteric symptoms (Harrison pp 857)

A

ORS and saltine crackers

47
Q

Suggested therapy for watery diarrhea (1-2 stools per day) with distressing enteric symptoms. (Harrison pp 857)

A

ADULTS:

  1. Bismuth subsalicylate 2 tabs (262mg/tab) every 30 min for 8 doses
  2. Loperamide 4mg initially followed by 2mg after passage of each unformed stools, NOT to exceed 8 tablets.
48
Q

Suggested therapy for watery diarrhea with 2 or more unformed stools per day (Harrison pp 857)

A

Antibacterial plus loperamide

49
Q

Dysentery or Fever of >37.8 (Harrison pp 857)

A

Antibacterial

NO loperamide for fever or with dysentery

50
Q

If with low suspicion for fluoroquinolone-resistant campylobacter what antibiotics should be started? (Harrison pp 857)

A

Fluoroquinolones: Ciprofloxacin 750mg as single dose OR 500mg BID for 3 days; Levofloxacin 500mg as single dose or 500mg OD for 3 days; Norfloxacin 800mg as single dose or 400mg BID for 3 days
Macrolides: Azithromycin 1000mg as single dose or 500mg OD for 3 days
Rifaximin 200mg TID or 400mg BID for 3 days (It is not recommended for dysentery

51
Q

Why is not recommended to start antimicrobial therapy for Enterohemorrhagic E. coli infections? (Harrison pp 857)

A

Antibiotics induced replications of Shiga toxin producing lambdoid bacteriophages (STEC) and 20x increases the risk of HUS

52
Q

Adverse effect of bismuth subsalicylate (Harrison pp 857)

A

Darkening of the tongue

Tinnutus

Infectious (7 decks)

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