DSA slides from McGowan Flashcards
1
Q
bacteria from chicken
A
salmonella
campylobacter
shifella
2
Q
Undercooked hamburger
A
EHEC (O157:H7 E coli)
3
Q
Fried rice
A
Bacillus Cereus
4
Q
Potato salad, mayo, or cream pastries
A
Staph Aureus
5
Q
Eggs
A
Salmonella
6
Q
Lunch meat and soft cheeses
A
Listeria
7
Q
Raw seafood
A
Vibrio!
-or norwalk, campylobacter
8
Q
Staph aureus
A
water diarrhea
- rapid onset
- preformed enterotoxins
9
Q
Bacillus Cereus
A
- preformed enterotoxins
- comiting
- rapid onset
- rapid resolution
- fried rice
- watery diarrhea
10
Q
Clostridium perfringens
A
- preformed enterotoxins
- watery diarrhea
- crampy abd pain
- rapid onset
- rapid res
- beef, ham, poultry, legumes, gravy: heat resistant spores inadequately cooked
11
Q
Shigella
A
- shiga toxin
- usually children (daycare)
- BLOODY diarrhea
- Fecal leukocytes
12
Q
Tx Shigella
A
BIsmuth, ampicillin, fluoroquinolone, or trimethoprim/sulfamethoxazole
13
Q
Complications of Shigella
A
- respiratory compliants and seizures (children)
- post infectious complications: REACTIVE ARTHRITIS AND HUS
14
Q
Which Shigella is the most common species in the united states?
A
Shigella sonnei
15
Q
Salmonella Typhimurium
A
- fram negative, non-lactose fermenting, motile, rod-shaped, bacteria
- Watery->bloody diarrhea
- fever
- Ingests contaminated food (eggs, poultry)
- animal exposure: reptiles
- Increased risk with sickle cell pts
- Stool culture is lactose (-) motile
16
Q
Are Abx indicated for Salmonella Typhimurium?
A
no!
-course of illness may be prolonged by it
17
Q
What are complications of Salmonella typhimurium?
A
reactive arthritis, endocarditis, septic arthritis, osteomyelitis
18
Q
Salmonella Typhi
A
- travel
- lives only in humans
- Typhoid fever: 103-104
- *rose spots rash
- Dx: samples of stool or blood
19
Q
Tx of salmonella typhi
A
Fluoroquinolones (becoming resistant), ceftriaxone, and azithromycin
20
Q
Campylobacter Jejuni
A
- Bloody diarrhea
- Guillian Barre syndrome
- Gram negative curved rod
- Spiral shaped, oxidase +, motile with flagellum
21
Q
Tx of campylobacter
A
supportive
-NO ABX NEEDED
22
Q
Vibrio cholerae
A
- O1 and O139 variants
- Toxin production
- watery rice water diarrhea (profuse)
- Curved/comma shaped, anaerobic gram- bacilli with flagellum
- waterborne illness (saltwater)
- Raw oysters (seafood)
- underdeveloped nations
23
Q
Tx of vibrio cholerae?
A
- rehydration/electrolyte replacement
- in africa and India
24
Q
Vibrio Parahemolyticus
A
Cytotoxin production
- Non-O1 and non O139 variants
- cause seafood associated diarrhea
- bloody diarrhea*
25
Vibrio Vulnificus
Gram negative bacillus
- warm shallow, coastal salt water*
- seafood
- open wound in water
- Bullous skin lesions
26
What kinds of patients are really in trouble if they have Vibrio Vulnificus?
Immunocompromised patients and
| -especially cirrhosis patients
27
Aeromonas Hydrophila
- Gram (-), non- spore forming rod, facultative anaerobic bacteria, motile with flagellum
- FRESHWATER environments or bracksih water
- Eating fish or shellfish
- necrotizing fasciitis
- 2 types: Cholera like (non bloody), and Bloody mucoid stools
- scuba divers that swallow small amounts of fresh water and then have gastroenteritis
28
Tx of Aeromona Hydrophila
Ampicillin
29
Most common cause of Travelers diarrhea
ETEC
| -affects small intestine
30
Ppl who go to russia and people who go camping a lot will get....
Giardia-associated diarrhea
31
Where is cyclospora found?
visitors to Nepal
32
What patients will have travelers diarrhea due to a Norwalk virus?
ppl who just went on a cruise ship
33
What kind of Diarrhea does ETEC give you?
the watery kind
34
What complication is much more likely to happen in EHEC than in shigella?
HUS
| -tx with abx
35
Yersinia Enterocolitica
- Higher risk in Iron-overload syndromes*, diabetes, and preexisting GI disorders
- bloody diarrhea
- Clinically indistinguishable form salmonella or shigella
- can mimic appendicitis*
36
Complications of Y. enterocolitica?
rash, reactive arthritis, and hemochromatosis*
37
Tx of yersinia
supportive
38
Listeria Monocytogenes
- preggos
- non-bloody diarrhea
- confirm Dx by blood culture
- deli meaths
- can multiply at refrigerator temps
- meningoencephalitis
39
Clostridium dicifile
- Anaerobic, gram +, spore forming bacillus
- cytotoxin production
- watery diarrhea
- Pseudomembranes on colonic mucosa
- PCR for toxin (A and B)
- *wash hands with soap and water***
40
Tx of Clostridium dificile?
PO/IV metronidazole, ORAL vancomycin
41
Main complication with C. diff
Toxic Megacolon
| -treat aggressively and surgery consult for colectomy
42
What is the most common cause of acute diarrhea in children <2 yo?
rotavirus
43
Rotavirus
- children <2yo
- watery diarrhea
- wagon-wheel appearance on electron microscopy
- Death can occur from dehydration
44
Tx rotavirus
supportive care
| -vaccine available
45
Norwalk virus
- older children and young adults
- Watery diarrhea
- symptoms within 24-48 hours
- cruise ships*
46
Tx of rotavirus
supportive care
47
Adenovirus (40 and 41)
- children (2nd to rotavirus as most common)
- Fever
- Watery diarrhea and vomiting
- conjunctivitis
- Pharyngitis
- lasts about 10 days
- Virus can shed for months after symptom resolution
48
Tx of Adenovirus
Supportive care
49
Cytomegalovirus (CMV)
- rare cause
- immunosuppressed patients
- reactivation of previous infection
- fever, abdominal pain, bloody diarrhea
- dx by doing endoscopy with bx of ulcerated lesions using CMV specific stains
50
Entamoeba histolytica
-Most common cause of dysentery in the world***
-Flask shaped ulcer
-Can penetrate bowel and into portal circulation..... LIVER ABSCESSES
-Toxic megacolon or pneumatosis coli
-needs treatment even if asymptomatic
(most are asymptomatic carriers)
-Stool antigen (PCR for DNA)
-crowded living conditions
51
Tx of Entamoeba histolytica
metronidazole and paromomycin
52
Giardia Lamblia
- pear shaped, 4 flagella, 2 nuclei protozoan
- Fecal-oral
- Watery (malodorous) diarrhea
- Stool antigen detection
- get it from water or daycare or Russia
53
Tx of Giardia Lamblia
Metronidazole
54
Which one was associated with and overcrowded swimming pool?
Cryptosporidium
- you're fine as long as you're not immunocompromised
- resistant to chlorine treatment
- watery diarrhea (large volume >20L a day)
55
Strongyloides Stercoralis
nematode: roundworm
- bare feet on contaminated soil
- enters body through exposed skin
- Rhabditiform larvae in stool, eosinophils in stool
56
Tx of Strongyloides Stercoralis
Ivermectin
57
Cyclospora cayetanensis
- Produce (like veggies) from endemic areas
- Travel to endemic areas (tropics)
- Watery diarrhea
- oocysts are hard to kill
- detect oocysts in stool sample
58
Tx of cyclospora cayetanensis
Trimethoprim/sulfamethoxazole (TMP/SMX)
59
Cystoisospora belli (used to be Isospora belli)
- watery diarrhea
- tropics
- repeated stool exams and concentration procedures are recommended
- if stool examinations are negative, do an examination of duodenal specimens by bx
- oocysts can be visualized by modified acid fast stain
60
Tx of Cysoisopora belli
Bactrim DS (TMP/SMX)
61
Ascaris Lumbricoides
- hook worm
| - Bowel obstruction
62
Diphyllobothrium latum
-fish tapeworm... from fish
63
Schistosoma mansoni
- most common cause of esophageal varices behind alcohol in africa
- fresh water snails
- blood stools, bladder cancer, liver cysts
64
Taenia solium
- pork tape worm, mostly asymptomatic
| - rare serious cases of seizures and muscle or eye disease
65
Echinococcus granulosus
- dog tapeworm
- cysts in liver or lungs
- looks like free-flowing "hydatid sand" on CT
66
What does an increase in fecal lactoferrin mean?
there is an inflammatory process behind the diarrhea
67
What are the only 2 organisms that will give us fecal leukocytes but not necessarily bloody diarrhea?
Listeria and clostridium
68
What are the only 2 penetrating things that cause diarrhea?
Salmonella typhi, Y. enterocolitica
69
What 2 things gave us rapid onset diarrhea?
Staph aureus or b. cereus
70
if there is diarrhea >16 hours after eating potato or egg salad and there's dysentery, what organism?
Shigella!
71
What do you not use in C diff or EHEC?
anti motility agents
| -you just need to shit them out
72
What kind of sanitation does NOT work for norovirus and C. diff?
alcohol gels.... they are Irishmen, they can handle their alcohol
73
For travelers, is prophylaxis with abx recommended?
no
74
What are some characteristics about pathogens that typically affect the small bowel?
Presents with: large volume, watery, abd cramps, weight loss
- WBC's absent in stools
- pain is mid abdomen or diffuse
- Dehydration/malabsorption
75
What pathogens typcally affect the small bowel?
```
Salmonella
Vibrio cholerae
ETEC
EPEC
Yersinia
Rotavirus
Norovirus
CMV
Adenovirus
Giardia
Cryptosporidium
Cyclospora
Clostridium perfringens
Staph aureus
Bacillus Cereus
```
76
What are some characteristics about pathogens that typically affect the large bowel?
Present with: frequency, small colume stools
- May be associated with: fever, blood or WBC's in stool (inflammatory), Fecal leukocytes common*
- Location: lower abd or rectum (tenesmus)
77
What organsims typically affeect large bowel?
```
Campylobacter,
salmonella
shigella
yersinia
EIEC
EHEC
C diff
Vibrio parahaemolyticus
E. histolytica
CMV
Adenovirus
Herpes simplex
```
78
What are people with hemochromatosis prone to?
invasive, even fatal enteric infection
- Vibrio and Yersinia infection
- should avoid raw fish
79
What are some common enteric pathogens in AIDS patients?
```
Mycobacterium
CMV
Adenovirus
HSV
Cryptosporidium
Cystoisospora belli
Microsporida
Blastocystis hominis
```
