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Cross: Inflamamtory Diarrhea Flashcards

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1
Q

Causes of inflammatory D

A 
****SEESSCCY****
Shigella
EHEC
EIEC
Salmonella enterica
Salmonella enteritidis**
C. jejuni
C. difficile
Yersinia enterocolitica
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2
Q

90% of infectious D=

A

viral etiology

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3
Q

D lasting longer than 10-14 days=

A

likely from a parasite

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4
Q

acute diarrhea

A

3 or more loose stools per day lasting less than 2 weeks

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5
Q

chronic diarrhea

A

more than 4 weeks-consider HIV status

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6
Q

bugs that cause D in HIV patients

A

MAI

CMV

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7
Q

define inflammatory D

A
  • small volume
  • often bloody (dysentery)
  • WBC/RBC’s in stool
  • fever is COMMON
  • most often affects colon
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8
Q

define non-inflammatory D

A
  • large volume
  • watery
  • non-bloody
  • no cells in stool
  • afebrile
  • SMALL INTESTINE USUALLY AFFECTED
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9
Q

general characters for Shigella, E. coli, Salmonella

A 
>Gram Negative
>glucose fermenting with acid production?
>Oxidase negative
>reduce nitrates to nitrites
ALL MOTILE EXCEPT SHIGELLA
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10
Q

flagellar antigens

A

H antigen

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11
Q

polysaccharide side chain on LPS

A

O antigen

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12
Q

Gram negative, NON-motile, NON-lactose fermenting, DOES Not PRODUCE H2S

A

Shigella

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13
Q

Strain of Shigella most commonly affecting US-school aged/day care children

A

Shigella sonnei-70% cases

DAYCARE CENTERS migrant workers, nursing homes, traveler to developing countries,

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14
Q

most common shigella strains worldwide

A
  1. Shigella dysenteriae

2. Shigella flexneri

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15
Q

how is shigella transmitted

A

fecal oral route-very low ID

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16
Q

shigella pathogenesis

EIEC has a similar mechanism

A

> taken up by M cells (resistant to gastric acid)
escape into LP-taken up by macs-> cause apoptosis
HOST INFLAMMATORY RESPONSE KILLE THE CELL IN WHICH IT IS MUTLIPLYING-ALLOWING IT TO ESCAPE
SPREADS FROM CELL TO CELL VIA MEMBRANE BOUND PROTRUSIONS -FORMINS-DEPENDENT ON HOST CELLULAR ACTIN POLYMERIZATION-LYSES MEMBRANES THAT SURROUNDS IT AND NOW IS FREE IN ADJACENT CELL

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17
Q

complications from Shigellosis

A
  1. reiter’s syndrome

2. HUS- from shiga toxin (AB toxin) more common with S. dysenteriae

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18
Q

TX for Shigellosis

A

Ceftriaxone
Ciprofloxacin
Azithromycin
*shortens course and reduces duration of organism shedding in tools

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19
Q

this bug can cause inflammatory and non-inflammatory diarrhea

A

E. coli

5 strains we are discussing here

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20
Q

how does shiga toxin work>

A

cleaves a base on the 28s of 60S subunit in Ribosomal subunit thus inhibiting protein synthesis

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21
Q

shiga toxin seen in

A

Shigella dysenteria
EHEC (Shiga toxigenic e coli) which include O157:H7
and O104: H4
*these are really “SHIGA-TOXIN-LIKE”

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22
Q

cannot ferment sorbitol-colonies white on culture

DISTINGUISHING FEATURE

A

EHEC-aka STEC

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23
Q

SOURCE OF EHEC

A

INADEQUATELY COOKED MEAT (HAMBURGERS)-CONTAM VEGGIES AND MIK-ALSO HUMAN-TO HUMAN

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24
Q

CAUSES HEMORRHAGIC COLITIS- HOSPITAL STAY IN 50%-SHIG TOXIUN LIKE S. DYSENTERIAE

A

EHEC

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25
ehec Is grouped into
O157:H7-like and | non O157: H7
26
locus of enterocyte effacement (LEE)
PAI within EHEC that contains a TYPE III secretion system-aids in attachment and effacement of the bug onto colonic mucosa via a pedestal formation and delivery of the e coli receptor to the host cell
27
responsible for the diarrhea in EHEC
LEE pathogenicity island
28
little fever, acute onset cramps and WATERY D-becomes bloody (hemorrhagic colitis) within 24 hours-lasts up to 8 days
EHEC
29
EHEC strain more likely to cause outbreaks, dysentery, HUS, ischemic colitis
O157:H7
30
which bugs use LEE for entry
EHEC and EPEC
31
feared complication of EHEC and Shigellosis (less common) | 5-10 days after diarrhea
``` HUS from SHIGA TOXIN IN BLOOD STREAM 90% of cases in children but only complicated 9% of EHEC cases 5% mortality rate 50% require dialysis-most regain function ```
32
main cause of AKI in children
HUS following EHEC infection
33
clinical features of HUS
``` microangiopathic hemolytic anemia and thombocytopenia AKI requiring dialysis in half 5-10 days after D SHISTOCYTES ON PBSMEAR neuro symptoms-seizure/somnolence ```
34
Dx of EHEC
1. Sorbitol MacCOnkey agar-white colonies | 2. Elisa for Shiga toxin A and B
35
Tx for EHEC
SUPPORTIVE care and monitoring >ab's are contraindicated-would spread toxin through lysis of cells-increased risk of HUS >anti-diarrheals are contraindicated
36
e. coli strain similar to Shigella sonnei causing a similar disease
EIEC food-water person-person transmission
37
movement from one cell to another for EIEC-
moves similar to Shigella sonnei-with actin polymers replicates intracellularly and extends into adjacent intestinal cells "formins"--not sure if it is exactlyt the same but cross lumped these two together by their means of pathogensis
38
doe EIEC mae toxins
no-in this way it is not like S. dystenteria
39
h2S producing non-lactose-fermenting gram negative BACillUS
salmonella
40
causative agents of TYPHOID fever
>Salmonella enterica subtype Typhimurium | >salmonella parathypi
41
causative agent of salmonellosis
NONTYPHOID salmonella Salmonella enteritidis *common cause fo food poisoning
42
does S enterica or paratyphi cause gastroenteritis?
HELL NAW
43
sources of Salmonella
chicken, eggs, dairy turtles lizards other reptiles human-human
44
taken up by M cells-TYPE III secretion system-bacterial prots allow for growth withing ENDOSOMES-invade LP-host response kills macrophages as well
Salmonella enteriditis
45
5% will develop invasive disease: bacteremia, endovascular infections, endocarditis, osteomyelitis. Predilection for aortic plaques, bone prostheses
salmonellosis S. enteriditis
46
reactive arthritis seen with which bugs
Salmonella enteriditis | Shigellosis
47
Dx of salmonella
stool culture
48
tx of salmonella
not required for healthy ppl-RESISTANCE IS AN ISSUE >only tx those at risk for disseinated infection KNOWN OR SUSPECTED ATHEROSCLEROTIC PLAQUES >IMMUNOCOMPROMISED-HIV SICKLE CELL
49
TX OF SALMONELLA WHEN INDICATED
FLOROQUINOLONES
50
TYPHOID FEVER CAUSED BY____AND PATHOGENSESIS resides in submucosa-peyer's patch hyperplasia
SALMONELLA-ENTERICA SUBTYPE THPHIMURIUM -taken up by M cells-gets in RES and LN's-spreads to blood (sepsis can occur)-HYPERTROPHY OF PEYERS PATCHES--necrosis follows-occasionally perforation
51
clinical presentation of typhoid fever
1st week-fever chills bactermia 2nd week-abdominal pain and rose spots 3rd week- hepatosplenomegaly (mainly spleen)-GI bleed, perforation-2ndary bactermia
52
Tx of typhoid fever-Salmonella enterica typhimurium
Ceftriaxone, Azithromycin, or cipro (Possibly resistance to florquinolone) VACCINE AVAILABLE
53
most common bacterial pathogen in the developed world
Campylobacter jejuni
54
thin spiral shaped GNR
c. jejuni
55
most important cause of traveller's diarrhea
C. jejuni | -ETEC is important too
56
Unpast milk, improper chicken, contam. water
c jejuni
57
reservoir for c jejuni
``` sheep cattle chicken wild birds dogs ```
58
tx of c jejuni
only for those w/ severe or at risk of severe dz -Azithromycin or Cipro (floro resistance on the rise)
59
clinical course of C jejuni
``` 1 week incubation 3-7 day course 10 bm's per day fever watery/bloody in 15% dx=stool culture ```
60
MOA for GBS
Guillain Barre Syndrome | -molec mimicry, antibodies to LPS cross-react with peripheral and central gangliosides
61
complications for c jejuni
>GBS >Reactive arthritis (along with shigella and salmonella enteriditis, yersinia) >Erythema nodosa
62
gram negative coccobacillus with bi-polar staining
Yersinia enterocolitica
63
pork, water raw milk, contaminated water, pet feces
yersinia enterocolitica
64
Yersinia clinical course
MIMICS APPENDICITIS -involves illeum, appendix, right colon -multiplies in lymph tissue=Peyer's patch hyperplasia and LN hyperplasia N/V/F/D-EN, Pharyngitis, arthralgia
65
right sided abdominal pain
yersinia enterocolitica
66
how to tell yersinia infection form appendicitis
look for pharyngitis arthralgia erythema nodosum
67
Tx/DX of yersinia
stool culture | most cases dont need tx
68
anaerobic spore forming GPR (transmitted via fecal oral route)
Clostridium difficile
69
important intermediaries of C diff
hospital workers hands
70
most common cause of AB associated dirrhea
c diff
71
ab's associated with c diff diarrhea
peniccillin, cephalosporins, tetracycline, ampicillin
72
most common nosocomial infection, and cause of nosocomial diarrhea
c difficile
73
C diff pathogenesis
EXOTOXINS A AND B THIS IS NOT AN A/B TOXIN!!!!! ENTEROTOXIN-TOXIN A CYTOTOXIN- TOXIN B * EACH WITH DIFFERENT FUNCTIONS - NOT AN A/B TOXIN
74
C DIFF PATHOGENESIS ENTEROTOXIN A
ENTEROTOXIN (TOXIN A)--> DISRUPTS COLONIC MUCOSAL CELL ADHERENCE TO BASEMENT MEMBRANE-DAMAGES VILLIOUS TIPS-LEADS TO FLUID SECRETION
75
C DIFF PATHOGENESIS CYTOTOXIN -TOXIN B
CAUSES DEOLYMERIZATION OF ACTIN -LOSS OF CYTOSKELETAL INTEGRITY-APOPTOSIS AND DEATH OF ENTEROCYTES
76
TOXIN A AND B (A>B) BOTH DO WHAT
STIMULATE MONOCYTES AND MAC -RELEASE IL8-> TISSUE INFILTRATIN WITH PMN'S -BOTH DISRUPT TIGHT JUNCTIONS OF EPITHELIA
77
SECRETION-DAMAGE TO VLIIOUS TIPS-BASEMENT MEMBRANE DETTACHMENT
ENTEROTOXIN-TOXIN A
78
DEPOLYMERIZATION OF ACTIN-APOPTOSIS AND DEATH OF ENTEROCYTES
CYTOTOXIN-TOXIN B
79
CLINICAL FEATURE OF C DIFF "CDAD w/ colitis"
* *WATERY DIRRHEA (10-15/DAY)-MAINLY - -PSEUDOMEMBRANOUS COLITIS- - fulminant colitisSEVERE (pain distention, fever hypovolemia) - toxic megacolon (>7cm dilated with severe systemic toxicity)
80
name the hypervirulent strain of Cdiffand the treatment
NAP-1/027 fidaxomicin
81
gold standard for dx of c diff
cell culture cytotoxicity assay | stool + monolayer of cultured cells-if cytotoxic

Gastrointestinal (9 decks)

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