Can cause family/community outbreaks, cruise ships
Norovirus
Who does norovirus tend to affect?
Older children, adults
Faecal/oral, waterborne, shellfish
Norovirus
Abrupt nausea, vomitting, diarrhoea, cramps, myalgia
24-48 hour incubation
Norovirus
When will norovirus resolve?
24-48 hours
Onset 1-6 hours after exposure
Diarrhoea, abdominal pain, afebrile
No blood or pus in faeces
Toxin mediated food poisoning (e.g. staph aureus, clostridium perfringens, bacillus cereus)
Fever, D&V, abdominal pain
Acute enteritis
Fever, pain, bloody diarrhoea
Acute colitis
Enteric fever like illness
Fever, rigors and pain but LITTLE diarrhoea
Infections that cause bloody diarrhoea
Camplyobacter
Shigella
E.coli O157
Amoebiasis
Food/water, poultry
Most common cause of bacterial infection
Camplyobacter
2-5 day incubation
Illness lasts 5-14 days
Camplyobacter
Associated with Guillain-Barre
Campylobacter
How does camplyobacter present?
Colitic syndrome - fever, pain, bloody diarrhoea
May mimic appendicitis
GI bleed
E. coli
CMV
Malabsorptive diarrhoea with bloating
Microsporidium
Giardia lamblia
Indian subcontinent, SE Asia, Far East, Middle East, Africa etc
Typhoid
What is key to diagnosis of typhoid?
Blood cultures
Test for salmonella
Stool culture
Test for Campylobacter
Stool culture
Test for Shigella
Stool culture
Test for C. difficile
Stool toxin (culture not routinely done!!)
Test for E. coli O157?
Cytotoxin
Test for salmonella
Blood culture
Test for Norovirus
PCR
How to assess severity of CDI?
- Suspicion of Pseudomembranous colitis (PMC) or toxic megacolon or ileus or colonic dilatation in CT/AXR >6cm
- WCC >15 cells/mm3
- Creatinine >1.5 x baseline
Complications of bacterial enteritis?
Severe dehydration and renal failure
Acute colitis, toxic dilatation
Post infective irritable bowel (very common)
Transient secondary lactose intolerance
Antimotility agents
Opiates, loperamide
avoid if dysentery symptoms
Anti-secretory agents
Chlropromazine
Bismuth subsalycilate
Empirical therapy
Ciprofloxacin 500mg BD for 3-5 days
Abx predisposing to C.diff infection
Cephalosproins
Clindamycin
Ciprofloxacin
Clarithromycin
Treatment for pseudomembranous colitis
Metronidazole (non-severe)
Vancomycin (severe)
Give both orally!!
Give metronidazole –> should improve 3-5 days, if not then start metronidazole!
Abx for shigellosis
Ciprofloxacin (quinolone)
Abx for campylobacter
Macrolide (azithromycin etc)
Community acquired/traveller’s diarrhoea
Salmonella Shigella Campylobacter E. coli C. diff
Nosocomial diarrhoea
C. diff
Persistant diarrhoea > 7 days
Giardia
Cryptosporidium
Treatment for traveller’s diarrhoea?
Ciprofloxacin and anti-diarrhoeals
Diagnosis of amoebiasis?
Examination of hot stool for ova and cysts
Treatment of amoebiasis?
Metronidazole
-remove from lumen by using diloxanide furoate or paromomycin
Associated with liver abscess?
Amoebiasis
Diarrhoea and malabsorption, often explosive
Giardiasis
Infection spread by cysts found in normal drinking water
Diagnosis= examination of hot stools for ova and cysts (more accurately by duodenal aspiration)
Giardiasis
Treatment for giardiasis
Metronidazole
How does amoebiasis present?
Acute bloody diarrhoea
What do you HAVE to do if extra-intestinal amoebiasis?
SEROLGY
Diagnosis of intestinal amoebiasis
Stool M&C
Probable cause of protracted diarrhoeal symtpoms
Giardiasis
Probable cause of protracted diarrhoeal symtpoms
Giardiasis
Cryptosporidosis treatment
Usually supportive