Clin - Acute Infectious Diarrhea Flashcards
(100 cards)
1
Q
cornerstone of diagnosis in acute infectious diarrhea
A
microbiologic analysis of the stool
2
Q
what bacteria are tested for in a routine stool culture
A
- salmonella
- shigella
- E. coli
- campylobacter
3
Q
if stool studies are unrevealing in acute infectious diarrhea, what diagnostic test should you do
A
endoscopy
- flexible sigmoidoscopy w/ biopsies
- upper endoscopy w/ duodenal aspirates and biopsies
4
Q
what do abd x-rays check for in acute infectious diarrhea
A
detect free intraperitoneal air
- assess for ileus or toxic megacolon
5
Q
what do abd CTs check for in acute infectious diarrhea
A
colitis
6
Q
bacteria found in uncooked foods, lunch meat, or soft cheeses
A
listeria
7
Q
pathogens found in raw seafood
A
- vibrio species
- salmonella
- acute hepatitis A
- norwalk virus
- campylobacter
8
Q
gram stain of s. aureus
A
gram positive cocci in clusters (like grapes)
9
Q
sx of s. aureus ingestion
A
1) watery diarrhea
2) N/V
(rapid onset within 6 hrs of ingestion)
10
Q
bacteria in cream pastries, potato salad, mayo
A
s. aureus
11
Q
gram stain of b. cereus
A
gram positive rods
12
Q
sx of bacillus cereus ingestion
A
1) watery diarrhea
2) vomiting (main sx)
(rapid onset within 6 hours of ingestion)
13
Q
bacteria in fried rice
A
b. cereus
14
Q
gram stain clostridium perfringens
A
gram positive spore-forming rod
15
Q
sx of clostridium perfringens ingestion
A
1) watery diarrhea
2) crampy abd pain
(rapid onset within 8-16 hours of ingestion)
16
Q
risk factors for clostridium perfringens ingestion
A
- beef, ham, poultry, legumes, gravy
- inadequately cooked food (it is HEAT RESISTANT)
17
Q
gram stain shigella
A
gram negative rods
18
Q
sx of shigella
A
1) watery diarrhea that becomes bloody
2) abd cramps
3) fever for 3-4 days
19
Q
diagnostic tests for shigella
A
1) fecal leukocytes
2) stool culture
20
Q
where is shigella found in food
A
potato or egg salad, LETTUCE, raw vegetables
21
Q
tx for shigella
A
bismuth, ampicillin, fluoroquinolone
22
Q
complications of shigella
A
reactive arthritis and HUS
23
Q
gram stain salmonella typhimurium
A
gram negative, non-lactose fermenting, motile, rod shaped
24
Q
are antibiotics indicated in salmonella typhimurium
A
nope
typhimurium is the non-typhoid salmonella
25
what patients are at increased risk for salmonella typhimurium
1) sickle cell patients
2) leukemia pts
3) HIV
26
complications of salmonella typhimurium
1) reactive arthritis
2) endocarditis
3) septic arthritis
4) abscesses
5) osteomyelitis
27
what food and animal exposures increases risk for salmonella typhimurium
- eggs, poultry
| - reptiles (turtles)
28
gram stain salmonella typhi
gram negative rod, anaerobic
29
sx salmonella typhi
typhoid fever 7-14 days after ingestion
- 2 symptomatic phases separated by asymptomatic phase
1) sustained 103-104 fever
2) weakness, HA, anorexia, RUQ pain, maculopapular rash, pea-soup diarrhea --> bloody diarrhea
3) encephalopathy, splenomegaly, conjuctivitis
30
diagnostic tests for salmonella typhi
1) stool culture
| 2) blood culture
31
gram stain c. jejuni
gram negative curved/spiral-shaped rod
| spiral shaped or comma shaped
32
associated with guillian-barre syndrome
campylobacter jejuni
33
gram stain v. cholerae
gram negative bacilli, anaerobic, curved/comma shaped, with flagellum
34
tx vibrio cholerae
rehydration/electrolyte replacement
35
gram stain vibrio parahemolyticus
gram negative bacilli w/ cytotoxin production
36
sx vibrio parahemolyticus
- N/V/abd cramps
- water --> bloody diarrhea
(lasts 2-5 days)
37
what foods can harbor vibrio parahemolyticus
seafood
38
gram stain vibrio vulnificus
gram negative bacillus
39
sx vibrio vulnificus
- vomiting/diarrhea/abd pain
| - pt with open wound in the water
40
risk factors for vibrio vulnificus
coastal salt water, raw shellfish
41
gram stain aeromonas hydrophila
gram negative bacillus, non-spore forming, facultatively anaerobic bacteria, motile w/ flagellum
42
sx aeromonas hydrophila
two types:
1) cholera like (non blood diarrhea, water rice water stools)
2) bloody mucoid stools
43
tx aeromonas hydrophila
ampicillin
44
risk factors for aeromonas hydrophila
1) fresh water environment
2) eating fish or shellfish
3) open wounds in water (foot and ankle most common)
45
scuba diver that swallowed small amounts of fresh water and then developed gastroenteritis
aeromonas hydrophila
46
visitors to russia who develop diarrhea
giardia
47
tx ETEC
- antibiotics
| - bismuth
48
diagnostic results in EHEC
1) peripheral leukocytes, anemia, thrombocytopenia
2) fecal leukocytes
3) fecal lactoferrin
4) shiga like toxin in stool culture
49
tx EHEC
1) supportive
2) rehydration
3) antibiotics only in severe cases (antibiotics can increase risk of HUS)
50
complications of EHEC
HUS
51
gram stain yersinia enterocolitica
gram negative coccobacili
52
abd cramping and pharyngitis
yersinia enterocolitica
53
what dz can yersinia enterocolitica mimic
appendicitis
54
what patients have higher risk for yersinia enterocolitica
those with derangements in iron metabolism
- iron overload syndromes
- cirrhosis
- hemochromatosis
- aplastic anemia
- thalassemia
55
gram stain listeria monocytogenes
gram positive rod
56
sx listeria monocytogenes
1) fever
2) non bloody diarrhea
3) headache, N/V
57
risk factors for listeria monocytogenes
- pregnant women
- extremes of age
- immunocompromised
- hemochromatosis
58
gram stain tropheryma whipplei
gram positive bacillus, not acid fast
59
diagnostic test for tropheryma whipplei
EGD with biopsy and periodic acid schiff (PAS)
60
sx tropheryma whipplei
1) fever
2) arthralgias
3) weight loss
4) malabsorption
5) chronic diarrhea
61
tx for tropheryma whipplei
antibiotics w/ drugs that cross the BBB
62
prognosis of tropheryma whipplei
if untreated, dz is fatal
63
gram stain c. difficile
anaerobic gram positive spore forming bacilli
64
diagnostic test for c. difficile
stool assay - PCR for toxin (A and B)
65
complications of c. diff
toxic megacolon
66
most common cause of acute diarrhea in infants (children <2)
rotavirus
67
virology of rotavirus
dsRNA
68
sx rotavirus
vomiting and watery diarrhea
69
"wagon-wheel" appearance on electron microscopy
rotavirus
70
virology adenovirus
dsDNA
71
sx adnovirus
- watery diarrhea and vomiting
- conjuctivitis
- pharyngitis
72
virology norovirus
small non-enveloped RNA virus
73
virology CMV
herpesvirus family: dsDNA (linear)
74
sx cytomegalovirus
fever, abd pain, bloody diarrhea
75
most common cause of dysentery in the world
entamoeba histolytica
76
parasitology of entamoeba histolytica
trophozoite
77
"flask-shaped" ulcer on histology
entamoeba histolytica
78
risk factors for entamoeba histolytica
1) mental health institutions
2) poor sanitation
3) contaminated food/water
4) endemic areas
79
complications of entamoeba histolytica
1) toxic megacolon
| 2) pneumatosis coli
80
parasitology of giardia lamblia
pear-shaped, 4 flagella, 2 nuclei protozoan (trophozoite)
81
risk factors giardia lamblia
1) water - hiking/camping
2) beavers, cattle, dogs, rodents, big horn sheep
3) daycare
4) contaminated water in russia
5) IgA deficiency pts
82
parasitology of cryptosporidium parvum
oocyst with 4 motile sporozoites
83
risk factors cryptosporidium parvum
1) swimming pools
| 2) daycare
84
parasitology strongyloides stercoralis
nematode (roundworm)
| - enters through bare feet
85
risk factors strongyloides stercoralis
pts with HTLV-1
86
sx cyclospora cayetanensis
1) watery diarrhea
| 2) malaise, anorexia, nausea, low grade fever
87
risk factors cyclospora cayetanensis
1) lettuce, fresh basil, imported raspberries
2) tx of water or food w/ chlorine or iodine is unlikely to kill cyclospora cayetanensis
3) endemic areas
88
sx cytoisospora belli
1) non-bloody water diarrhea
| 2) crampy abd pain
89
risk factors for cytoisospora belli
tropical and subtropical areas
| - spread by ingesting contaminated food or water
90
what parasite can cause B12 deficiency
diphyllobothrium latum
91
sx and transmission of schistosoma mansoni
1) 2nd most common cause of esophageal varices in africa
| 2) contaminated freshwater snails
92
sx schistosoma mansoni
blood stools, bladder CA, liver cysts
93
compare sx b/w taenia solium and taenia saginata
solium: mostly asymptomatic, but rarely cause seizures and muscle or eye dz
saginata: mostly asymptomatic
94
transmission and sx of echinococcus granulosus
- sheep, dogs, poor sanitation
| - cysts in liver or lungs
95
in what patients should you prescribe anti-motility agnets
those without fever and non-blood stools
| NOT in c. diff or EHEC
96
nutrition recommendations for infectious diarrhea
1) BRAT diet (bananas, rice, applesauce, toast)
2) easily digestible foods (potatoes, crackers, yogurt, soup)
3) rice water
97
alcohol gels for hand sanitation are ineffective against what pathogens
C. diff and norovirus
98
what pathogens cause reactive arthritis (Reiter's syndrome) with arthritis, urethritis, and conjuctivitis
- salmonella
- campylobacter
- shigella
- yersinia
99
compare sx b/w pathogens infecting the small bowel and large bowel
small bowel: large volume, watery stools, and cramps, weight loss, dehydration/malabsorption, no WBCs
large bowel: frequent small volume stools, may have: fever, blood or WBCs in stool, fecal leukocytes
100
pts with hemochromatosis are at risk for what pathogens
vibrio species, listeria, yersinia
