acute infectious diarrhea Flashcards
clin med (126 cards)
1
Q
major cause of death in infectious diarrhea
A
dehydration
2
Q
sx of enterotoxin-producing bacterial infection
A
small bowel hypersecretion –>
profuse, watery diarrhea
marked vomiting
min fever
occurs abruptly within a few hours after ingestion
3
Q
sx of enteroadherant pathogens causing infectious diarrhea
A
small bowel hypersecretion–>
mild vomiting
high levels of abd cramping + bloating
high fever
4
Q
sx of cytotoxin producing and invasive microorganisms causing infectious diarrhea
A
high fever
abd pain
5
Q
5 high risk groups for infectious diarrhea
A
travelers immunodeficient daycare families institutionalized (assisted living) consumers of certain foods
6
Q
what agents are daycare workers/attendees/ and families especially at risk of being infected by
A
shigella
giardia
cryptosporidium
rotavirus
7
Q
signs of mild, mod, and severe dehydration
A
mild= thirs, dry mouth, less sweating and urination, weight loss
mod= orthostatic fall in BP, skin tenting, sunken eyes
severe= lethargy, obtundation, feeble pulse, hypotension, shock
8
Q
most cases of acute infectious diarrhea are ___ and ____, so you ____ do an extensive work up
A
mild
self-limited
dont need to
9
Q
explain the steps in treating infectious diarrhea
A
first find if it is likely infectious
(Y or N, still treat w fluid and electrolyte replacement)
if mild diarrhea, just observe until further proof
(then trx with plan for severe)
if mod diarrhea, but not other systemic sx then just give them antidiarrheal agents
if severe OR mod with (F>38,bloody stools, increased fecal WBC, x immunity, or old person) OR persistent mild diarrhea—> get a stool study and treat w specific/empirical trx
10
Q
indications for evaluation of infectious diarrhea
A
profuse with dehydration hypotension and tachy not responsive to volume repletion dysentery fever > 38.5 duration >48 hrs w no improve recent abx use (bc c dif) severe abd pain >70 immunocompromised cr > 1.5xnormal peripheral leukocytes >15k
11
Q
what organisms can be caught on a routine stool culture
A
salmonella
shigella
E. Coli
campylobacter
takes 24-48 hours
12
Q
what organisms do you need to specifically get a stool bacterial culture to be able to see?
A
EHEC E Coli (specifically ask for shiga like toxin)
vibrio
yersinia
13
Q
what organisms do you need to specifically get a stool immunoassay to be able to see?
A
C. Dif PCR/toxin
14
Q
what organisms do you need to specifically get a stool protozoal Ag to be able to see?
A
giardia
cryptosporidium
E. hystolitica
15
Q
what organisms do you need to specifically get a stool viral PCR/Ag to be able to see?
A
rotovirus
norwalk/norovirus
16
Q
if stool studies are unrevealing for infectious diarrhea, what can you do next
A
endoscopy w biopsy
17
Q
why should you order an xray with infectious diarrhea
A
with an abd xray you can check for free intraperitoneal air, ileus, or toxic megacolon, all of which could be complications of bacterial infection
18
Q
what time of year and what situational context should make you consider bacterial diarrhea/food poisoning
A
summer time, food be sitting out a long time
after multiple illnesses reported after a shared meal
19
Q
what bacterial agents can be caused by eating infected chicken
A
salmonella
campylobacter
shigella
20
Q
what bacterial agents can be caused by eating infected undercooked hamburger
A
EHEC
21
Q
what bacterial agents can be caused by eating infected fried rice
A
bacillus cereus
22
Q
what bacterial agents can be caused by eating infected potato salad, mayo, or cream pastries
A
staph aureus
23
Q
what bacterial agents can be caused by eating infected eggs
A
salmonella
24
Q
what bacterial agents can be caused by eating infected lunch meat, soft cheese
A
listeria
25
what bacterial agents can be caused by eating infected seafood
vibrio, salmonella, acute Hep A, norovirus, campylobacter
26
what bacterial agents can be caused by eating infected beef, ham, legumes, gravy
C. perfringens
27
microbio of staph aureus
G+ cluster, has preformed enterotoxins
28
sx and trx of staph aureus infectious diarrhea
N/V, watery diarrhea, within 6 hours of ingestion
trx= rapid resolution within 1-2 days
29
microbio of bacillus cereus
G+ rods, preformed enterotoxins
30
sx and trx of bacillus cereus infectious diarrhea
mainly vomiting, some watery diarrhea within 6 hours of ingestion
trx= rapid resolution within 1-2 days
31
microbio of C perfringens
G+, heat resistant spore forming Rod
| preformed enterotoxins
32
sx and trx of C. Perfringens
watery diarrhea and cramping abd pain, onset within 8-16 hours of ingestion
trx= rapid resolution with 1-2 days
33
most common type of shigella in the US
shigella sonnei, subgroup D
34
classic cause of dysentery:
| beginning with watery diarrhea w blood and pus---> bloody diarrhea
shigella
35
sx and diagnostic tools for shigella
watery diarrhea ---> dysentery
small volume diarrhea
abd cramps
fever 3-4 days
dx= + fecal leukocytes, stool cultures ~ to IBD, lactose -
36
trx for shigella
bismuth, ampicillin, flouroquinolones, or trimethoprim/sulfamethoxazole
37
sx of salmonella typhimurium
watery --> bloody diarrhea, 5-10 days
| fever, abd cramping, N/V, fecal leukocytes (+)
38
trx for salmonella typhimurium
is self limited to 5-10 days and abx not indicated
39
reptile exposure (spec. = turtles) can lead to infectious diarrhea caused by
salmonella typhimurium
40
what are the two sx phases in typhoid fever
1. sustained febrile illness, 103-104 w weakness, HA, anorexia, "pea soup", foul-smelling diarrhea --> bloody diarrhea, rose colored spots on skin
asx hitus
2. bacteremia -->encephalopathy, splenomegaly, brady+dicrotic pulse, conjunctivitis, intestinal perforation, intestinal hemorrhage
41
dx and trx for salmonella typhi
ds= stool and blood cultures, fecal leukocytes +
trx= prevent with hand washing and good food prep
flouroquinolones, ceftriazone, azithromycin
42
sx of C. jejuni
watery--> bloody diarrhea
fever
crampy abd pain
erythema nodosum
43
microbio of C jejuni
G- curved/spiral shaped rod,
44
dx and trx of C jejuni
dx= fecal leukocytes +, stoolcultures NEED CAMPY BLOOD AGAR
trx= self limited to a 1 week, so just give supportive care
45
dx test for cholera
stool microscopy and gram stain
see rods darting around
46
what organism are you at risk of being infected by with raw oysters and/or salt water infected in sewage
cholera
| virbio vulnificus
47
microbio of vibrio parahemolyticus
G- bacilli, cytotoxin production
48
sx of V. parahemolyticus
N/V, cramps, watery-->bloody diarrhea, 2-5 days
49
dx and trx of vibrio parahemolyticus
dx=fecal leukocyte +, stool culture request special
trx- self limited
50
microbio of vibrio vulnificus
G- bacillus
51
sx of vibrio vulnificus
= vomiting, diarrhea, abd pain within 16 hrs of ingestion
ballous skin lesions aka necrotic
*is life threatening in an immunocompromised person, especially w cirrhosis and hemochromatosis*
52
microbio of A. hydrophila
G-, non-spore forming, rod shaped, motile
53
sx of A. hydrophila
two types=
cholera like= watery rice water stools
or bloody mucoid stools
often wounded in fresh water env at the foot ankle, can rapidly progress to narcotizing fascitis
54
trx for A. hydrophilia
ampicillin
55
what is a classic presentation of someone with A. hydrophila
a scuba diver that swallows small amounts of fresh water and then has gastroenteritis
any fresh or brackish water, either eating fish or getting wounded in the water
56
what risk factors can make someone vulnerable to contracting traveler's diarrhea
H2 blocker/PPI
57
most common pathogen for traveler's diarrhea
ETEC
58
infection commonly associated with visits to Russia, and campers
giardia
59
infection commonly associated with cruise ships and daycares
norovirus
60
microbio for ETEC
G- rod
61
dx for ETEC
last 3-6 days
fecal leukocyte is (-)
diagnose clincally bc stool cultures don't differentiate between strains of E. Coli
62
trx for E Coli
abx that can reduce infection time
| trimethoprim/sulfamethoxazole/doxycycline, ciproflaxaxin
63
sx of EHEC infections
watery ---> bloody diarrhea
acute hemorrhagic colitis
typically NO fever
64
dx for EHEC and trx
CBC to check for leukocytes, anemia, thrombocytopenia
fecal leukocytes (+)
fecal lactoferrin (+)
trx= supportive care, rehydration, NO GIVE ABX or else get HUS only give abx if they're actually about to die
65
what populations have a high risk of yersinia infection
derangements of iron metabolism enhances virulence soo --> cirrhosis, hemochromatosis, aplastic anemia, thalassemia, DM
66
microbio of listeria
G+, can grow in the cold
67
risk factors for listeria infections
pregnancy
extremes of age and immunocompromised
contaminated deli meats
pregnant lady eats cheese
68
dx and trx for listeria
need blood cultures
trx= ampicillin and TMP/SMX
69
trx for T. whipplei (G+)
= whipple ds
abx therapy, prolonged trx for a year is required
cross the BBB- first cetriaxone, meropenem, followed by TMP/SMX
after trx, do repeated duodenal biopsies +spinal tap for at least a year to make sure its gone
70
microbio of C. Dif
anaerobic, G+, spore forming bacillus that is exotoxin mediated
71
dx for C. Dif
stool assay, PCR for toxin A or B
+ peripheral leukocytosis
pseudomembranes seen on sigmoidoscopy
72
which drugs specifically have higher risk of C Dif infection
clindamycin
cephalosporins
flouroquinolone
73
trx for c dif
PO/IV metronidazole
| PO vancomycin
74
what is a very serious complciation of c dif infection
toxic megacolon, with 60% mortality, needs aggressive trx and surgery consult
75
most common nosocomial infections
C Dif, norovirus
76
sx and stool findings in a case of proximal small bowel infection
watery diarrhea
(-) fecal leukocytes, no increase in fecal lactoferrin
77
sx and stool findings in a case of colon or distal small bowel infection
dysentery/inflammatory diarrhea
fecal polymorphonuclear leukocytes
increase in fecal lactoferrin
78
sx and stool findings in a case of distal small bowel infection
enteric fever
fecal mononuclear leukocytes`
79
sx, dx, and trx for rotavirus
sx= [6 months-->2 year olds] vomiting and watery diarrhea -->severe dehydration
self limiting usually,
dx= (-) fecal leukocytes, detected by viral culture/PCP, ECM shows wagon wheel appearance
trx= support and vaccinate
dehydration-->death
80
adenovirus population
children, second most common cause of gastroenteritis in children (after rota virus)
81
sx, dx, and trx of adenovirus infection
high fever (103-104), myalgia, watery diarrhea, conjunctivitis, 10 day course, pharyngitis
dx= viral culture
trx- support
82
population at risk for noro
older children and adults
83
sx, dx, and trx for norovirus
sx= vomiting, watery diarrhea, lasting 3 days
dx= (-) fecal leukocytosis, routine viral cultures, need a work up
trx= supportive care
84
population associated with CMV infection
immunosuppressed
85
sx and dx of CMV
fever, blood diarrhea for several weeks
dx= endoscopy w biopsy of ulcerated lesions using CMV specific stains
86
dx of E histolytica
flask shaped ulcer on histology,
stool for ova & parasite
stool Ag
fecal leukocytes (+)
acute narcotizing colitis
87
trx for E. hystolytica
eliminate the invading trophozoites (metronidazole or tinidazole)
eradicate intestinal carriage --> paromomycin or iodoquinol
88
microbio of giardia
pear shaped, 4 flagella
89
sx, dx, and trx of giardia
sx= watery smelly diarrhea, weight gain, flatulence, steatorrhea, malase,
dx= fecal leukocytes (-), ova parasites, stool Ag detection
trx= tinidazole, metronidazole
recurrence is common
90
clinical presentation of cryptosporidium parvum
in immunocomp ppl= self limited dairrhea (1-2 weeks(
in immunosuppressed, life threatening and possible indefinate
>20 L of watery diarrhea a day
91
what organism are you at risk of bring infected by in a public pool
cryptosporidium
92
dx and trx of cryptosporidium
```
dx= stool Ag or modified acid fast stainig, DFA (direc flourescence Ab)
fecal leukocytes (-)
```
trx= resistant to chlorine trx,
hydration,
loperamide, nitazoxsnide, trx AIDS if present
93
those infected with HTLV-1 are more susceptible to infection by
strongyloides stercoralis
94
sx, dx, and trx of strongyloides stercoralis
sx= often asx, or bloating, V/D, perianal urticaria, migratory rash
dx= rhabditiform larvae in stool
trx= anti-helmintic
95
what organism are you at risk of bring infected by from imported produce (basil, raspberries)
cyclospora cayetanensis
96
sx, dx, and trx of cyclospora cayetanensis
sx= low grade fever, watery dairrhea, anorexia lasting up to 21 days if immunocomp, indef if immunosupp
dx= fecal leukocyte (-), detect oocyte in stool
trx= TMP/SMX
97
cystoisospara belli sx, dx, and trx
sx= acute watery diarrhea, crampy abd pain, malabsorption and weight loss
can be v severe in immunosupp, infants, and children
dx= repeated stool exams and concentrations, if (-) do a duodenal biopsy, visualize oocytes on wet mount or acid fast stain
trx= prevent, bactrim DS (TMP/SMX)
98
soil transmitted hookwork that is ingested fromthe soil and can get really long to cause bowel obstruction
ascaris lumbricoides
99
fish tapeworm from raw fish that can grow up to 30 ft and cause B12 deficiency
diphyllobothrium latum
100
consequences of vit B12 deficiency
pernicious anemia and neuro sx
101
most common infectious cause of esophageal varices in africa
most common cause of small portal V branch obstruction
method of infection and sx and trx
schistosoma mansoni
from contaminated freshwater snails, cause bloody stools, bladder CA and liver cysts
trx= praziquantel
102
pork tapeworm, cause seizures and muscle or eye ds
taenia solium
103
beef tapeworm, mostly asx
taenia saginata
104
tapeworm from unsanitary sheep slaughter or dogs
complications
echinococcus granulosus
form cysts in liver or lungs
looks like free-flowing "hydatid sand" on CT
105
E. vermicularis sx, dx, trx
(pinworm)
severe perianal itching
scotch tape test
trx= mebandazole
106
when can anti-motility trx be used to treat infectious diarrhea
what two organisms can you NOT use anti-motility agents for
in patients with
NO fever
NON-bloody stools
C. dif and EHEC
107
nutrition and diet recommendations for infectious diarrhea
BRAT diet (banana, rice, applesauce, toast)
easily digestible foods
rice water
avoid lactose and high fiber foods
108
what two agents are hand sanitizer ineffective against
norovirus
c. dif
WASH YO HANDS BIOTCH
109
what organisms can be vaccinated against
rotavirus
s. typhi
v. cholera
hep A
110
what prophylaxis can be given to travelers to avoid travelers diarrhea
bismuth subsalicylate (s.e. of dark tongue and stools)
abx prohylaxis= cirprofloxacin, azithromycin, rifaximin
111
what agents can cause reactive arthritis aka reiter's syndrome
reiter's syndrome= arthritis, urethritis, conjunctivitis (cant see, cant pee, can't climb a tree)
salmonella, campylobacter, shigella, yersinia
112
complications of yersinia infection
yersiniosis
autoimmune type thyroiditis
pericarditis
glomerulonephritis
113
what organisms can lead to HUS? prognosis?
EHEC (O157:H7)
shigella
high mortality rate, with microangiopathic hemolytic anemia, thrombocytopenia, renal insufficiency
114
differentiate between the sx of a small bowel infection and a colon infection
small bowel= watery stool, dehydration/malabsorp, weight loss, NO WBCs in stool, pain either diffuse or in midabd
large bowel= frequent small volume stools, blood or WBCs in stool, lower abd/rectal pain
115
organism with high infection in IgA deficiency
giardia
116
people with hemochromatosis are at higher risk for infection by
vibrio species
listeria
yersinia
117
AIDS pts are more susceptible to...
mycobacteria
CMV, adenovirus, herpes
cryptosporidium, C. belli, microsporida, B. hominis,
N. gonnorrhea, T. pallidum, chlamydia
118
once salmonella typhi infects the ___, you become a carrier
GB
119
infants with watery or bloody diarrhea are likely to have
which histologically looks like
EPEC
loss of villi= ephacement
120
non-bloody persistent diarrhea without a fever
| more severe in immunocompromised
EAEC
121
young kids in developing countries with fever, pain, dysentery
EIEC
122
sx of C. dif
dehydration
hypoalbuminia
fever
waterry, smelly diarrhea
123
hangs out on heart valves --> heart murmur
| steatorrheacommon in white farmers
whipple ds
124
the rotavirus vaccine is linked to ____, and is contraindicated in _____ patients bc it is a live vaccine
intussusception
| immunocompromised
125
most common cause of viral conjunctivitis in kids
adenovirus
126
sx of e histolytica
```
abd pain
bloody diarrhea
weight loss
necrotizing colitis
megacolon
```
