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GI II Final - Mik > Bugs > Flashcards

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1
Q

S. aureus

shape & stain, toxins, symptoms, contraction

A 
Gram + cocci in clusters
preformed enterotoxins
N/V, watery diarrhea
rapid onset within 6 hours;
rapid resolution 24-48 hours
Contracted from ham, poultry, dairy, EGGS, CREAM PASTRIES, POTATO SALAD, MAYONNAISE
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2
Q

Bacillus cereus

shape & stain, toxins, symptoms, contraction

A 
Gram + rods
Preformed enterotoxins
Vomiting (mainly), watery diarrhea
Rapid onset within 6 hours;
rapid resolution 24-48 hours
Contracted from FRIED RICE, meats, veggies, dried beans, cereals
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3
Q

Clostridium perfringens

A

Gram + spore-forming rods
Preformed enterotoxins
Watery diarrhea (no fever or vomiting), crampy abd pain
Rapid onset within 8-16 hours;
Rapid resolution within 24-48 hours
Contracted from beef, ham, poultry, legumes, gravy (inadequately cooked)

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4
Q

Shigella spp
shape & stain, toxin, Symptoms, Contraction,
Dx, Tx, Complications

A

Gram - Rods, nonmotile
Shiga toxin
dystentery: bloody diarrhea (begins watery -> bloody with fever), abd cramps
Lasts 1-2 weeks
Tests: fecal leukocytes +, lactose - on stool culture
Tx: bismuth, ampicillin, fluoroquinolone, or trimethoprim/sulfamethoxazole
Complications: respiratory complaints and seizures (children), reactive arthritis, HUS

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5
Q

Reactive arthritis

A

Can’t see, can’t pee, can’t climb a tree

  • conjunctivitis - discharge, erythema, burning, photophobia
  • urethritis - dysuria, urgency, frequency, discharge
  • arthritis - knees/ankles/feet
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6
Q

Salmonella typhimurium

shape & stain, symptoms, contraction, Dx, Tx, complications

A

gram -, non-lactose fermenting, motile, rod-shaped
watery -> bloody diarrhea, fever, abd cramping, N/V
Lasts 5-10 days, self-limited
Fecal leukocytes +
Contraction by food, esp EGGS, POULTRY, milk/dairy products, beef, shellfish or from animals - TURTLES, ducks, birds
Increased risk with immunocompromised (esp sickle cell)
Labs: stool culture
Do NOT give antibiotics
Complications: reactive arthritis, endocarditis, septic arthritis, osteomyelitis

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7
Q

Salmonella typhi

shape & stain, transmission, symptoms, Dx, Tx

A

gram - rod
International travel (humans are the only carrier), poor sanitation, fecal-oral
Sx: typhoid fever: systemic sustained febrile, high ever, weakness, headache, anorexia, RLQ pain, rash of flat rose-colored spots, diarrhea
Dx: samples of stool or blood; fecal leukocyte +
Tx: fluoroquinolones, ceftriaxone, azithromycin

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8
Q

Campylobacter jejuni

shape & stain, transmission, Sx, Dx, Tx, complications

A

gram - curved/spiral shaped rod
ingestion of raw/undercooked meat (POULTRY), diary (raw milk), birds and ducks are hosts, cross-contamination during food prep, contaminated water
Self-limited watery -> bloody diarrhea, fever, cramps abd pain
Dx: stool culture with campy blood agar, oxidase +, motile
Tx: supportive
Complications: 1-8 weeks post diarrhea: reactive arthritis, Guillian-Barre Syndrome

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9
Q

Vibrio cholerae

shape & stain, Sx, transmission, Dx, Tx

A

gram - bacilli, anaerobic, curve/comma shaped with flagellum
N/V, abd cramping, profuse watery (rice water) diarrhea, dehydration
12-48 hour incubation
waterborne illness (saltwater); eat raw oysters, sewage)
Duration: 1 week
Dx: stool microscopy
Tx: rehydration, antibiotics

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10
Q

Vibrio Parahemolyticus

shape & stain, toxin, transmission, Dx, Sx

A

gram - bacilli
cytotoxin production
Sx: N/V, abd cramps, watery -> bloody diarrhea
Dx: fecal leukocyte +, stool culture
Lasts 2-5 days
Sea-food associated: shellfish, oysters, shrimp

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11
Q

Vibrio Vulnificus

shape & stain, transmission, Sx

A

gram - bacillus
transmitted in coastal salt water through open wounds, and eating raw shellfish (oysters)
Sx: vomiting, diarrhea, abd within 16 hours of ingestion, bullies skin lesions
*life-threatening in immunocompromised (esp cirrhosis and hemochromatosis)

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12
Q

Aeromonas hydrophila

shape & stain, transmission, Sx, Tx

A

gram -, non-spore forming, rod-shaped, motile
fresh water environment, eating fish or shellfish, foot and ankle wounds in water
Sx: necrotizing fasciitis, cholera-like (watery rice water stools) OR bloody mucoid stools
Tx: ampicillin

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13
Q

Causes of Travelers diarrhea

A

most common = ETEC
Others: campylobacter (Asia), salmonella, shigella, aeromonas, EAEC, coronavirus, Giardia (Russia, campers, backpackers, swimmers in wilderness), Cyclospora (Nepal), Norovirus (cruise ships)

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14
Q

ETEC

shape & stain, transmission, Sx, Dx, Tx

A

gram - rod
ingestion of contaminated food or water
Sx: N, occasional fever & vomiting, watery diarrhea
Sudden onset, 3-6 day duration
Dx: fecal leukocyte -
Tx: Antibiotics (trimethoprim/sulfamethoxazole, doxycycline, ciprofloxacin), bismuth

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15
Q

EHEC

shape & strain, toxin, transmission, Sx, Tx, complications

A

(O157:H7) gram - rod, shiga-toxin
food-borne: undercooked meat, raw veggies, raw milk, unpasteurized apple cider
animal contact
Sx: watery -> bloody diarrhea -> ischemic colitis, no fever, peripheral leukocytes +, fecal leukocytes +
Tx: supportive, rehydration
Complications: HUS 5-10 days into course; more likely in kids and if treated with antibiotics

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16
Q

Other E. coli

A

EAEC - persistent diarrhea in kids
EPEC - infantile watery or bloody diarrhea
EIEC - fever, abd pain, watery -> bloody diarrhea with leukocytes (dysentery)

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17
Q

Yersinia enterocolitica

shape & strain, transmission, Sx, Dx, Tx, complications

A

gram - coccobacilli
transmission by contaminated food/water or dairy, contaminated domestic animal feces
Sx: bloody diarrhea, fecal leukocytes +, fever, cramps, N/V, Abd pain & pharyngitis
Duration 10-20 days
Dx: stool/blood cultures
Tx: supportive care
Complications: rash, reactive arthritis
Note** - higher risk in those with derangements of iron metabolism, diabetes, and preexisting GI disorders
Note** - can mimic appendicitis

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18
Q

Listeria monocytogenes

shape & strain, transmission, Sx, Dx, Tx, Complications

A

gram + rod
get from contaminated food (raw milk, unpasteurized diary, and deli meats)
Sx: fever, non-bloody diarrhea, headache, N/V 2-3 days duration
Dx: blood culture or CSF, stool cultures
Tx: ampicillin and trimethoprim/sulfamethoxazole
Complications: causes meningoencephalitis and listeria placentis

  • Note it has a predilection for pregnant women, extremes of age, immunosuppressed, and those with hemochromatosis
  • Note that this can grow at cold temps
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19
Q

Clostridium difficile

shape & strain, toxin, transmission, Sx, Dx, Tx, complications

A

anaerobic, gram +, spore-forming bacillus
Cytotoxin production (exotoxin mediated)
Transmission: within last 2 months - hospital stay or ill contact? antibiotic use? Especially clindamycin, cephalosporins, and fluoroquinolones? PPI?
Sx: watery diarrhea, abd pain, fever, peripheral leukocyte +, pseudomembranes on colonic mucosa
Dx: stool - PCR for toxin
Tx: PO or IV metronidazole, PO vancomycin
Complication: toxic megacolon

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20
Q

Rotavirus

type, age, transmission, Sx, Dx, Tx

A

double stranded RNA virus
infants (children < 2), can occur in adults
spread via fecal-oral
Sx: vomiting and watery diarrhea, severe dehydration, fecal leukocytes -
symptoms begin within 72 hours and last 2-3 days, up to 5
Dx: viral culture or PCR, “wagon wheel” appearance on electron microscopy
Tx: supportive care

  • Note: death can occur by dehydration
  • Note: most common cause of acute diarrhea in infants
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21
Q

Adenovirus

type, age, Sx, Dx, Tx

A 
double stranded DNA virus
children
Sx: fever, chills, myalgias, sore throat, watery diarrhea, vomiting, conjunctivitis, pharyngitis
prolonged course (10 days)
Dx: viral culture
Tx: supportive

*Note: most common cause of viral conjunctivitis in children

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22
Q

Norwalk/Norovirus

type, age, transmission, Sx, Tx

A

small non-enveloped RNA virus
older children and adults
fecal-oral transmission; outbreaks via contaminated food, water, person-person
Sx: vomiting, watery diarrhea (4-8 stools/day)
symptoms within 24-48 hours, lasts 3 days
Tx: supportive care

*Note: strong association with nursing homes, child care centers, schools, and CRUISE SHIPS

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23
Q

Cytomegalovirus

type, population, Sx, Dx

Study These Flashcards
A

herpes virus family - double-stranded linear DNA
primarily immunosuppressed/AIDS patients, CD4 < 200
Sx: fever, abd pain, bloody diarrhea
persists for several weeks
Dx: endoscopy with biopsy of ulcerated lesions using CMV stains

24
Q

Entamoeba histolytica

characteristic, transmission, Sx, Dx, Tx, complications

Study These Flashcards
A

“flask-shaped ulcer”
Transmitted fecal-oral in crowded living conditions
Endemic in Asia, Africa, Central and South America
Sx: fever, tenesmus, bloody diarrhea, abd pain, fecal leukocyte +
Persists for days-weeks
Dx: stool for ova and parasite, stool Ag (PCR for DNA)
Tx: metronidazole and paromomycin
Complications: can penetrate bowel -> portal circulation -> liver abscesses, toxic megacolon or pneumatosis coli

*Note: most common cause of dysentery in the world

25
Giardia lamblia | characteristic, transmission, Sx, Dx, Tx
pear-shaped, 4 flagella, 2 nuclei protozoan fecal-oral transmission, acquired through water (lakes and streams), hiking/camping, beavers, Russia, daycares Sx: watery (malodorous) diarrhea, steatorrhea, flatulence, abd pain, belching, weight loss, nausea, malaise, cramps, anorexia, bloating, fecal leukocyte - lasts 14-28 days Dx: check stool for ova parasites, stool Ag detection Tx: metronidazole
26
Cryptosporidium (self-limited and life-threatening) | population, transmission, Sx, Dx, Tx
life-threatening in immunosuppressed patients (AIDS CD4 < 200) transmission: water borne organisms, contaminated food/water, outbreaks with swimming pools, unsanitary milk production, municipal water supplies, person-person Sx: nausea, malaise, abd cramping, large volume of watery diarrhea, fecal leukocyte - (in AIDS patients -> biliary Dz also) Dx: stool Ag detection or direct microscopy modified acid-fast staining, direct fluorescent Ab Tx: supportive care, AIDS = antivirals to increase CD4
27
Strongyloides stercoralis | type, transmission, Sx, Dx, Tx
nematode: roundworm enter body through exposed skin from contaminated soil Risk factors: poor, rural, institutionalized, immunocompromised Sx: Abd pain, bloating, diarrhea, cough, SOB, perianal urticaria, migratory rash Dx: rhabditiform larvae in stool, eosinophils in stool Tx: anti-helminthic
28
Cyclospora cayetanensis | transmission, Sx, Dx, Tx
transmitted via produce imported from endemic areas: lettuce, basil, raspberries, travel to endemic areas: tropical and subtropical regions Sx: malaise, anorexia, nausea, low fever, watery diarrhea, fecal leukocytes - can last 21 days in immunocompetent, indefinitely in immunosuppressed Dx: oocysts in stool sample Tx: TMP/SMX
29
Cystoisospora belli | endemic, transmission, Sx, Dx, Tx
Most common in tropical and subtropical areas Spread by contaminated food or water Sx: acute, non-bloody, watery diarrhea with abd cramping can last for weeks -> malabsorption & weightless, eosinophilia Dx: repeat stool examinations for oocysts Tx: TMP/SMX
30
Ascaris lumbricoides | type, transmission, Sx
hookworm, fecal oral transmission, can cause bowel obstruction
31
Diphyllobothrium latum | type, transmission, Sx
fish tapeworm, transmission with raw/undercooked fish, can cause B12 def -> pernicious anemia
32
Schistosoma mansoni | endemic, transmission, Sx
Africa, transmitted by freshwater snails through skin, causes bloody stools, bladder cancer, liver cysts *Note: 2nd most common cause of esophageal varies in Africa
33
Taenia solium | type, Sx
pork tapeworm, mostly asymptomatic -> rare, serious cases of seizures and muscle or eye disease
34
Echinococcus granulosus | type, transmission, Dx
tapeworm transmitted by unsanitary livestock, especially sheep and dogs, humans are infected fecal-oral, poor sanitation through infected dogs form cysts in liver or lungs looks like free-flowing "hydatid sand" on CT
35
Name the symptoms of a pathogen that commonly affects the small bowel
Presents with: large volume, watery stools, abdominal cramps, weight loss, fecal leukocytes -, mid abdomen or diffuse pain, dehydration/malabsoprtion
36
Name examples of pathogens that commonly affect the small bowel (15)
Salmonella, Vibrio cholerae, ETEC, EPEC, Yersinia, Rotavirus, Norovirus, CMV, Adenovirus, Giardia, Cryptosporidium, Cyclospora, Clostridium perfringens, Staph aureus, Bacillis cereus
37
Name the symptoms of a pathogen that commonly affects the large bowel
Presents with: frequent, small volume stools | May be associated with fever, blood in stool, fecal leukocyte +, lower abd or rectum pain
38
Name examples of pathogens that commonly affect the large bowel (12)
Campylobacter, Salmonella, Shigella, Yersinia, EIEC, EHEC, C. diff, Vibrio parahaemolyticus, E. histolytic, CMV, Adenovirus, Herpes simplex
39
What infections are AIDS patients more likely to acquire? (10)
Cryptosporidium, Cystoisospora belli, Cyclospora, Salmonella, Campylobacter, Shigella, Mycobacterium avium complex, CMV, Herpes, Adenovirus
40
What infections are patients with hemochromatosis more likely to acquire? (3)
Vibrio species, Listeria, Yersinia infections
41
HAV | family, prodrome, duration, risk factors, Sx, Labs, vaccine, acute/chronic, mortality
family: hepatovirus/picornavirus family, single stranded RNA genome prodrome: anorexia, N/V, malaise, aversion to smoking Duration: 2-3 weeks Risk factors: international travel, contaminated water or food, shellfish Sx: fever, malaise, myalgia, arthralgia, UR, anorexia, enlarged and tender liver, jaundice, N/V, diarrhea/constipation Labs: markedly elevated AST/ALT, mild proteinuria, bilirubinuria, anti-HAV Ab, IgG anti-HAV (in the absence of IgM) indicates previous exposure Vaccine: HAV vaccine in US Acute only Low mortality
42
HBV | family, prodrome, duration, risk factor, Sx, Transmission, Labs, Vaccine, acute/chronic, complications
Family: hepadnavirus, partially double-stranded DNA genome Prodrome: anorexia, N/V, malaise, aversion to smoking Duration: 2-3 weeks Risk factors: men who have sex with men, those at hemodialysis centers, previously incarcerated, previously treated for STI, drug abusers Sx: low grade fever, enlarged and tender liver, jaundice; may also be associated with glomerulonephritis, serum sickness, and polyarteritis nodosa Transmission: endemic in Africa and Southeast Asia Labs: markedly elevated aminotransferases early in course Vaccine: yes 90% acute & recover Complications: cirrhosis, HDV superinfection, hepatocellular carcinoma (men > women)
43
What does the HBV serology look like during the window period?
HBsAg -, Anti-HBs -, Anti-HBc IgM +, Anti-HBc IgG -, HBeAg -, HBV DNA -
44
What does the HBV serology look like during the acute infection?
HBsAg +, Anti-HBs -, Anti-HBc IgM +, Anti-HBc IgG -, HBeAg +, HBV DNA +
45
What does the HBV serology look like with prior infection?
HBsAg-, Anti-HBs +, Anti-HBc IgM -, Anti-HBc IgG +, HBeAg -, HBV DNA -
46
What does the HBV serology look like with chronic infection?
HBsAg +, Anti-HBs -, Anti-HBc IgM +, Anti-HBc IgG +, HBeAg +, HBV DNA +
47
What does the HBV serology look like with immunization?
HBsAg -, Anti-HBs +, Anti-HBc IgG -, Anti-HBc IgG -, HBeAg -, HBV DNA -
48
What does HBsAg indicate?
surface Ag, first evidence of infection, positive during acute and carrier (chronic) state
49
What does HBsAb indicate?
surface Ab, immunity to HBV
50
What does HBcAg indicate? HBcAg IgM/IgG?
core Ag IgM = appears shortly after HBsAg is detected, only thing detectable during the GAP/Window period -> considered acute HBV IgG = appears during late in acute phase and persists indefinitely whether person gets chronic infection or immunity (prior infection)
51
What does HBeAg indicate?
correlates with viral proliferation and infectivity, positive during acute and active chronic, negative in the inactive chronic carrier state
52
What does HBV DNA indicate?
detectable during current infection, typically parallels the presence of HBeAg
53
HDV | family, risk factors, labs, vaccine, mortality
Family: defective virus that requires HBV for replication Risk Factors: co-infects with HBV or supenrinfects those with HBV, endemic along Mediterranean Basin where it spreads non-percutaneously Nonendemic areas it spreads percutaneously in HBsAg+ IV drug users or hemophiliac transfusion Labs: Anti-HDV serum Vaccine: vaccinate against HBV Mortality: enhances severity of HBV
54
HEV | Family, Duration, Risk Factors, Transmission, Labs, Acute/Chronic, Mortality, Complications
Family: RNA hepevirus Duration: self-limited Risk Factors: epidemic form in Asia, Middle East, North Africa, Central America, India; having a pet in the home or consuming undercooked organ meat are risk factors Transmission: enterically - waterborne epidemics, undercooked meat, spread by swine Labs: IgM anti-HEV Acute/Chronic: acute, no carrier state Mortality: high in pregnant women Complications: arthritis, pancreatitis, thrombocytopenia, Guillian Barre, peripheral neuropathy
55
HCV | Family, Duration, Risk Factors, Sx, Labs, Acute/Chronic, Complications, Tx
Family: flavin-like virus Duration: most commonly chronic Risk Factors: not sexual, confection with HIV-infected persons, IV drug use, body piercing, tattoos, hemodialysis Sx: clinically mild and asymptomatic Labs: Anti-HCV in serum; most sensitive = HCV RNA, enzyme immunoassay that detects Abs to HCV Acute/Chronic: >50% likelihood of chronicity Complications: cirrhosis, hepatocellular carcinoma, HIV co-infection, mixed cryoglobulinemia, chronic HCV infection is associated with a decrease in serum cholesterol Tx: curable

GI II Final - Mik (1 decks)

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