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Clinical Pathology > CP11-9 GI Infections Part 2 > Flashcards

CP11-9 GI Infections Part 2 Flashcards

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1
Q

What is the second leading cause of death in children under 5?

A

Diarrhoeal disease

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2
Q

what is the most common cause of diarrhoeal disease?

A

Non-food bourne e.g. hand hygiene

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3
Q

What are some physical factors to prevent diarhoeal disease?

A

Food and water hygiene
Hand washing
Animal contact

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4
Q

What are some host factors that can prevent diarrhoeal disease?

A

Healthy Microbiome
Stomach acid barrier
Local immune responses

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5
Q

What are some interventions used to prevent diarrhoeal disease?

A

Vaccines
Antimicrobial treatments
Rehydration therapies

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6
Q

What are some categories of disease causing gastroenteritis/diarrhoea?

A

Food borne
Non-foodborne
Viral
Waterborne
Antibiotic-associated

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7
Q

What are two subtypes of food borne/waterborne gastroenteritis?

A

Intoxication
Infection

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8
Q

What is the difference between intoxication and infection gastroenteritis?

A

Intoxication = ingestion of pre formed toxin with a rapid incubation period. Non communicable and causes more systemic symptoms.

Infection = ingestion of bacteria, virus or parasite with a slow incubation period. Communicable, usually faecal-orally, causing more localised systems in GI tract.

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9
Q

What causes intoxication gastroenteritis?

A

Inadequate cooking
Improper hand,ink temperatures

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10
Q

What causes you to get pathogens causing infectious gastroenteritis?

A

Inadequate cooking
Cross contamination e.g. of cooked and raw meat
Poor hygiene and hand washing

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11
Q

What foods are associated with gastroenteritis?

A

Dairy
Eggs
Meats including ground beef, poultry, pork
Seafood especially oysters
Some vegetables
Mayonnaise
Rice
Canned food including honey

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12
Q

Who is not allowed to have honey?

A

Children under 1 due to risk of foodbourne gastroenteritis

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13
Q

How does staph aureus cause gastroenteritis?

A

Heat stable enterotoxin of staph aureus causes nausea and vomiting (no diarrhoea) around 4 hours after ingestion.

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14
Q

What are the two type of bacillus cereus associated GI infection?

A

Heat stable emetic toxin = vomiting without diarrhoea 1-4 hours after eating cooked rice usually

Heat labile toxin = little vomiting but precise diarrhoea 12-14 hours after eating

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15
Q

How does clostridium perfringens cause gastroenteritis?

A

Causes abdominal cramps and watery diarrhoea 1-4 hours caused by heat labile toxins of c. Perfringes after eating contaminated meat products

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16
Q

How does clostridium botulinum cause gastroenteritis in adults?

A

Neurotoxin produced by c. Botulinum causes blurred vision, respiratory failure and flaccid paralysis 1-2 days after eating contaminated canned food

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17
Q

How does clostridium botulinum cause gastroenteritis in infants?

A

C botulinum spores - usually in honey - colonise the infant’s GI tract and produces toxins causing constipation and neurological symptoms (milder disease than adults)

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18
Q

How does salmonella cause gastroenteritis?

A

6-8 hours after eating high dose from contaminated poultry, birds and some reptiles causing cramps, diarrhoea, fever, myalgia, nausea and vomiting

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19
Q

What is the most common type of salmonella?

A

Salmonella enteritidis

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20
Q

How are intoxification food borne gastroenteritis treated?

A

With supportive measures as contaminated with toxin not actual pathogen

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21
Q

When are antibiotics given to salmonella associated gastroenteritis?

A

If affected individual is:
>50
Immunocompromised
Has cardiac valve disease or e do vascular abnormalities

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22
Q

What antibiotic is given to those who need it for salmonella associated gastroenteritis?

A

Ciprofloxacin

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23
Q

What gastroenteritis occurs from shingella species?

A

Dysentery = watery, bloody, mucoid stool with associated stomach pain. Causes fluid and enterolyte loss. Only requires small dose to become ill 36-72 hours after infection.

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24
Q

How is shingella associated gastroenteritis treated?

A

Only with antibiotics if individual has sever disease, is immunocompromised or has bloody diarrhoea

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25
What antibiotic is given to patients with shingella associated gastroenteritis?
Ciprofloxacin
26
What should not be prescribed to patients with shingella associated gastroenteritis?
Anti motility drugs e.g. loperamide or diphenoxylate
27
What is characteristic of campylobacter associated gastroenteritis?
Watery diarrhoea, nausea, vomiting, malaise and headache due to production of heat labile toxin 2-5 days after ingestion. Associated with poultry, birds and rascal oral transmission.
28
How should campylobacter associated gastroenteritis be treated?
With fluid and electrolyte replacement if necessary Antibiotics if severe or worsening symptoms, immunocompromised, or symptoms lasting >1 week
29
What antibiotic is given to patients with campylobacter associated gastroenteritis who need it?
erythromycin
30
What e.coli can cause gastroenteritis?
E.coli 0157
31
How does e.coli 0157 cause gastroenteritis?
Found in contaminated cattle and meat and can produce shiga toxin causing watery diarrhoea and then bloody diarrhoea after 2-5 days.
32
What are complications of e.coli 0157 associated gastroenteritis?
10-15% develop haemolytic uraemic syndrome Other complications include, acute renal failure, thrombocytopenia and microangiopathic haemolytic anaemia
33
How should e.coli 0157 associated gastroenteritis be treated?
Supportive only NO antibiotics NO anti mobility drugs e.g. loperamide or diphenoxylate, or opioids NO NSAIDs
34
What are the 5 main types of e.coli associated gastroenteritis?
Enterohaemorrhagic (VTEC) Enterotoxigenic (ETEC) enteropathogenic (EPEC) enteroaggregative(EAEC) enteroinvasive (EIEC)
35
What can yersinia enterocolitica cause?
In young children = fever, abdo pain, diarrhoea +/- blood Older children and adults = fever, pain on right abdomen
36
What can listeria monocytogenes cause?
Serious gastroenteritis in pregnant women, newborns, immunocompromised and people >65 from unpasteurised dairy products e.g. soft cheese
37
How does vibrio parahaemolyticus and plesiomomas shigelloides cause gastroenteritis?
Comes from raw seafood and can cause severe disease in immunocompromised. Symptoms include abdo pain, fever, nausea, vomiting, muscle aches and headaches lasting 24hours-3 days.
38
What are the 5 main viruses causing viral gastroenteritis?
Rotavirus Adenovirus Norovirus Astrovirus Calicivirus
39
How does rotavirus associated gastroenteritis present?
With diarrhoea, vomiting and fever (usually in children) lasting 5-7 days
40
How does adenovirus associated gastroenteritis present?
With diahrroea, vomiting and fever in infants and young children lasting 5-12 days
41
How does norovirus associated gastroenteritis present?
With acute vomiting, diarrhoea, fever, myalgia, headache lasting 1-2 days affecting everyone and especially rife in hospitals, nurseries, nursing homes and cruise ships
42
How does entamoeba histolytica associated gastroenteritis present?
With water diarrhoea and then bloody diarrhoea, nausea, vomiting, tenesmus and malaise after ingesting contaminated food or water usually 15 days after exposure.
43
What is a complication of entamoeba histolytica?
Liver abscesses
44
How is entamoeba histolytica associated gastroenteritis also known?
Amoebic dysentery
45
How is amoebic dysentery treated?
Always prescribe antibiotics for confirmed cases If acute invasive or liver abscesses with metronidazole or tinidazole followed by 10 days of diloxanide furoates. Asymptomatic with cysts in faeces = diloxanide furoate.
46
How does cryptosporidosis present?
Watery diarrhoea, weight loss and low grade fever or severe chronic diahroea in immunocompromised which develops 2-10 days after exposure from animals, fish, reptiles or contaminated water.
47
Who is treated for cryptosporidosis and how?
Only necessary for immunocompromised and treatment is aimed at underlying condition, and very occasionally patients are given nitazoxanide but unproven benefit
48
What is giardiasis?
Giardia intestinalis associated gastroenteritis presenting with foul-smelling, watery diarrhoea, cramps, steatorrhoea and flatulence that has a sudden onset 1-4 weeks after exposure with contaminated water and can lead to chronic relapsing of diarrhoea
49
How is giardiasis treated?
Metronidazole for all confirmed cases or tinidazole
50
What is cholera?
Abrupt, ‘rice water’ stool causing significant fluid loss and hypovolemic shock 12 hours-5 days after ingestion of cholera toxin from water or food (especially shellfish)
51
How is cholera treated?
Oral rehydration if not severe Antibiotics for moderate to severe dehydration e.g. with tetra/doxycycline or ciprofloxacin
52
What causes enteric fevers?
Infection with salmonella typhi causing fever, headache, malaise, anorexia, constipation/diarrhoea 6-30 days after exposure Infection with salmonella paratyphi causing diarrhoea, splenomegaly, high fever and rose spots 1-10 days after exposure
53
What is the immune response to salmonella typhi/paratyphi?
Engulfed by macrophages and migrate to the liver, spleen and bone marrow
54
How should enteric fever be treated?
Immediate antibiotics - usually azithromycin - for all confirmed cases unless, multiple resistant then have fluoroquinolone or cefixime,or quinlone resistant then prescribe azithromycin or ceftriaxone
55
What is the most common bacteria associated with antibiotic associated diarrhoea?
Clostridium difficile
56
How does c. Diff associated gastroenteritis present?
Foul smelling, watery diarrhoea, Cramps and Low grade fever + potentially PMS, toxic megacolon or death due to toxin mediated inflammation and spores aid transmission
57
What are risk factors for c. Diff associated diarrhoea?
Antibiotics Age >65 Hospital stays
58
How is c. Diff associated gastroenteritis diagnoses?
By demonstration of toxin as well as organism
59
How is c.diff/antibiotic associated gastroenteritis treated?
Stopping current antibiotics predisposing the diarrhoea Start on vancomycin or fidaxomicin
60
What is strep gallolyticus associated with?
Infective endocarditis and septicaemia in elderly Associated with colorectal cancer
61
How is strep gallolyticus modelled to promote colorectal cancer?
1 - metabolite production by s. gallolyticus causes gallocin secretion by pre-neoplastic epithelium causing microbial imbalance which may lead to malignancy 2- high colonisation induces inflammation accelerating transformation of pre-malignant to malignant epithelium
62
How does mycobacterium tuberculosis associated gastroenteritis present?
With abdominal pain, weight loss, anaemia , tiredness and night sweats.
63
How is gastrointestinal TB treated?
If no CNS involvement with isoniazid, rifampicin, pyrazinamide and ethambutol for 2 months then isoniazid and rifampicin for a further 4 months
64
How often does c.diff infection recur?
30%

Clinical Pathology (65 decks)

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