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Bacterial Gastroenteritis Flashcards

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1
Q

How is bacterial gastroenteritis diagnosed? (4)

A
  1. bacteria culture on selective media
  2. confirm ID of colonies
  3. antimicrobial susceptibility testing
  4. multiplex PCR
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2
Q

What species of campylobacter cause gastroenteritis?

A
  1. c. jejuni
  2. c. coli
  3. c. foetus
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3
Q

When do campylobacter cases peak?

A

summer

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4
Q

How do people contract campylobacter? (2)

A
  1. raw or undercooked foods

2. cross contamination from raw to cooked/ready to eat foods

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5
Q

What is the pathogenesis of campylobacter in the GIT?

A

attach to and invade the GI epithelium of the jejunum, ileum, colon, rectum

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6
Q

What is the incubation period of campylobacter infection?

A

1-7 days

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7
Q

What are the clinical features of campylobacter infection? (5)

A
  1. abdominal pain
  2. diarrhoea (may be bloody)
  3. nausea
  4. vomiting
  5. fever
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8
Q

what are the complications of campylobacter infection? (2)

A
  1. guillain-barre syndrome

2. reactive arthritis

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9
Q

How is campylobacter managed? (3)

A
  1. rehydration
  2. electrolyte replacement
  3. antimicrobials usually not indicated
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10
Q

When should antibiotics be considered? (5)

A
  1. worsening symptoms
  2. symptoms lasting >1 week
  3. severe disease
  4. immunocompromised
  5. pregnant
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11
Q

What antibiotics can be used to treat campylobacter infections if neccessary? (2)

A
  1. macrolides

2. fluoroquinolones

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12
Q

What is the morphology of campylobacter?

A

gram negative curved bacilli

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13
Q

What selective media is used to culture campylobacter?

A

charcoal based selective media - flat colonies

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14
Q

How is campylobacter diagnosed in a lab?

A
  1. culture on charcoal based selective media
  2. susceptibility testing
  3. PCR
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15
Q

What salmonellae cause enteric fever? (2)

A
  1. salmonella enterica serotype typhi

2. salmonella enterica serotype paratyphi

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16
Q

What are non-typhoidal salmonellae? (2)

A
  1. salmonella enteritidis

2. salmonella typhimurium

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17
Q

Where is enteric fever found?

A

developing countries

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18
Q

What are the routes of transmission of enteric fever? (3)

A
  1. contaminated food and water
  2. poor sanitation and hygiene
  3. person to person occasionally
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19
Q

What is the pathogenesis of salmonella enterica?

A
  1. penetration of small intestinal epithelium

2. proliferation in submucosa - hypertrophy of peyers patches

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20
Q

What is the incubation period for enteric fever?

A

usually 2 weeks

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21
Q

What are the clinical features of enteric fever? (10)

A
  1. fever
  2. chills
  3. relative bradycardia
  4. abdominal pain
  5. rose spots
  6. hepatosplenomegaly
  7. GI bleeding
  8. perforation
  9. diarrhoea
  10. constipation
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22
Q

What are the complications of enteric fever?

A
  1. GI perforation
  2. seeding
  3. carriage
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23
Q

How is enteric fever diagnosed? (3)

A
  1. blood culture
  2. faeces culture
  3. bone marrow culture
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24
Q

How is enteric fever treated? (3)

A
  1. rehydration
  2. fluoroquinolones
  3. 3rd generation cephalosporins
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25
How can enteric fever be prevented? (3)
1. sanitation 2. hygiene 3. vaccination
26
How is non-typhoidal salmonellosis transmitted?
1. contaminated food and water 2. exotic pets 3. person to person
27
What is the incubation period for non-typhoidal salmellosis?
6-48 hours
28
How long does diarrhoea last in NTS?
3-7 days
29
How is NTS treated?
1. rehydration | 2. antimicrobial usually not required
30
When is antimicrobial use indicated in treating NTS?
1. severe illness 2. less than 1 or over 50 3. HIV 4. immunocompromised
31
How is Salmonella diagnosed? (3)
1. selective media - salmonella shigella agar 2. serotyping - antigen determination 3. PCR
32
What is antigens does salmonella have? (3)
1. O cell wall 2. H flagella 3. Vi Surface
33
What is EHEC and VTEC?
enterohaemorrhagic e coli | verocytotoxin producing e coli
34
What is ETEC?
enterotoxigenic e coli
35
What is EIEC?
enteroinvasive e coli
36
What is EPEC?
enteropathogenic e coli
37
What is EAEC?
enteroaggregative e coli
38
What is the important serotype of VTEC?
O157
39
When is the peak of VTEC?
seasonal pattern - summer peak
40
What is the main reservoir of VTEC?
cattle
41
What is the pathogenesis of VTEC?
release of verotoxin - shiga like toxins causing haemorrhagic colitis and haemolytic uraemic syndrome
42
What is the incubation period of VTEC?
3-4 days
43
What are the symptoms of VTEC?
diarrhoea may be bloody
44
What is a complication of VTEC that 5-10% develop?
haemolytic uraemic syndrome
45
What happens in haemolytic uraemic syndrome? (2)
1. renal failure | 2. haemolytic anaemia and/or low platelets
46
What is the treatment for VTEC? (2)
1. rehydration | 2. antibiotics not of proven value
47
How is VTEC cultured? (2)
1. sorbitol MacConkey agar | 2. test non-fermenters with antiserum
48
How is VTEC diagnosed? (2)
1. culture | 2. PCR
49
What is shigellosis?
bacterial dysentery
50
What are the species of shigella that cause human illness? (4)
1. s sonnei 2. s flexnari 3. s boydii 4. s dysenteriae
51
Who is at risk for shigellosis? (2)
1. children | 2. MSM
52
How is shigella transmitted?
1. faecal-oral route | 2. person to person
53
What cells does shigella adhere to and invade?
M cells of peyers patches
54
What is a complication of s dysentariae infection?
shiga toxin mediated haemolytic uraemic syndrome
55
What is the incubation period of shigellosis?
1-3 days
56
What are the clinical features of shigellosis? (3)
1. abdominal cramps 2. fever 3. bloody diarrhoea
57
What is s flexneri associated with?
reactive arthritis
58
How is shigellosis managed? (2)
1. rehydrate | 2. antibiotics usually not indicated
59
When is antibiotic use indicated in shigellosis?
1. immunocompromised 2. severe disease 3. food handler 4. childcare provider 5. institutional resident
60
How is shigellosis diagnosed?
1. selective media - XLD | 2. PCR
61
What causes s aureus gastroenteritis?
ingestion of pre-formed heat stable enterotoxin
62
What are the characteristics of s aureus gastroenteritis?
1. rapid onset 2-6 hours | 2. short lived 6-12 hours
63
What are the symptoms of s aureus gastroenteritis? (6)
1. malaise 2. nausea, 3. vomiting 4. abdominal pain 5. diarrhoea 6. NO fever
64
What are the enterotoxins produced by bacillus cereus? (2)
1. diarrhoeal toxin | 2. emetic toxin
65
What are the characteristics of bacillus cereus emetic syndrome? (3)
1. ingestion of toxin in food 2. illness within 1-5 hours 3. lasts 6-24 hours
66
What are the characteristics of bacillus cereus diarrhoeal syndrome?
1. toxin produced in small bowel 2. illness within 8-16 hours 3. lasts 24 hours
67
What are the bacterial characteristics of clostridioides? (4)
1. anaerobic 2. spore forming 3. gram positive 4. bacilli
68
What species of clostridiodes causes food poisoning?
c. perfringens
69
What species of clostridiodes causes antibiotic related diarrhoea?
c difficile
70
What is the commonest food source of c perfringens?
pre-cooked meat
71
how does c perfringens cause food poisoning? (2)
1. heat resistant spores | 2. enterotoxin production
72
What is the incubation period of c perfringens food poisoning?
8-12 hours
73
What are the symptoms of c perfringens food poisoning? (2)
1. abdominal cramps | 2. diarrhoea
74
What toxins does c difficile produces?
toxins A and B
75
What c difficile strains are hypervirulent?
1. 027 | 2. 078
76
What is the pathogenesis of c difficile? (4)
1. toxin mediated 2. colonic inflammation 3. mucosal damage 4. intestinal fluid secretion
77
What are the risk factors for c difficile infection? (6)
1. antimicrobials 2. advanced age 3. hospitalisation 4. GI surgery 5. immunosuppression 6. proton pump inhibitor use (?)
78
What antimicrobials put you at risk for c difficile infection?
1. broad spectrum penicillins 2. clindamycin 3. cephalosporins 4. fluoroquinolones
79
What are the clinical features of c difficile infection? (5)
1. watery diarrhoea 2. abdominal cramping/pain 3. colitis 4. fever 5. elevated WCC
80
What are the complications of c difficile infection? (3)
1. pseudomembranous colitis 2. toxic megacolon 3. colonic perforation
81
What is the two step process for diagnosing c difficile infection?
1. ELISA for glutamate dehydrogenase OR PCR | 2. ELISA for toxin detection
82
How is non-severe c difficile managed? (3)
1. vancomycin po 2. fidaxomicin po 3. metronidazole po
83
How is severe c difficile managed? (4)
1. vancomycin po 2. metronidazole iv 3. surgical review 4. intravenous immunoglobulin
84
What are the risk factors for recurrence of c difficile infection?
1. concomitant antimicrobial use during CDI treatment 2. 027 infection 3. elderly
85
What is the treatment for the 1st recurrence of c difficile infection?
fidaxomycin po
86
What is the treatment for the 2nd recurrence of c difficile infection? (3)
1. tapering vancomycin po 2. fidaxomicin po 3. faecal microbiota transplant
87
How can c difficile spread be prevented?
1. single room isolation 2. contact precautions 3. hand hygiene 4. environmental cleaning
88
How does vibrio cholerae spread?
contaminated food and water
89
What are the virulence factors of v cholerae
1. pili | 2. cholera toxin
90
What is the incubation period of v cholerae?
2-3 days
91
What are the symptoms of v cholerae infection? (2)
1. rice water stools | 2. effortless vomiting
92
What are the clinical features of v cholerae infection? (4)
1. dehydration 2. hypovolaemia 3. cardiac arrhythmia 4. renal failure
93
What is v cholerae cultured on?
Thiosuphate Citrate Bile salt Sucrose TCBS
94
How is v cholerae managed?
1. rehydration with fluids and electrolytes 2. tetracyclines 3. co-trimoxaxole

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