Flashcards in Gastroenteritis and Food Poisoning Deck (138):
1
What condition causes GI symptoms, diarrhoea, vomiting, abdominal pain and relates to invasion of tissue +/- toxin production?
Food poisoning
2
What is the commonest cause of food poisoning?
Campylobacter
3
What cause of food poisoning is rare, but can lead to morbidity and outbreaks?
E coli O157
4
What two organisms have a short incubation period of 1-6 hours?
Staph aureus and Bacillus cereus
5
What two organisms have a medium incubation period of 12-48 hours and there is invasion/toxin in gut which can often cause blood diarrhoea?
Salmonella
CI perfringens
6
What 2 organisms have a long incubation period of 2-14 days and can cause bloody diarrhoea?
Campylobacter and E coli O157
7
How long does it take for labarotory confirmation of bacteria?
48 hours for culture result
8
What two food products can campylobacter come from?
Raw milk
Poultry
9
Which organism rarely causes outbreaks, occurs in small numbers and results in pain, blood and a fever?
Campylobacter
10
What is the treatment for campylobacter?
Ciprofloxacin/erythromycin
11
What 3 food products can salmonella enteritidis come from?
Poultry, meat, raw egg
12
Where is salmonella occuring?
In animal gut
13
What is the treatment for salmonella enteritidis, which causes diarrhoea, vomiting, blood and fever?
Ciprofloxacin
14
What are the three most common groups of salmonellae?
B, C and D
15
What king of diarrhoea does E coli O157 cause?
Bloody
16
Is the infectious dose low or high for E coli O157?
Low
17
What two food products can E coli O157 come from?
Beef and raw milk/water
18
How can E coli O157 be transmitted?
Person to person
19
What toxin does E coli O157 produce?
Verotoxin (VTEC)
20
What organism can cause bloody diarrhoea nad haemorrhagic colitis?
E coli O157 VTEC
21
What syndrome can Haemolytic Uraemic Syndrome (HUS)?
E coli O157
22
`What three things does verotoxin do?
1. Binds to receptors found on renal cells, RBC and others
2. Inhibits protein synthesis
3. Causes cell death
23
What is this a presentation of: abdominal pain, fever, pallor, petechiae, blood diarrhoea and oliguria?
HUS
24
What patients are commonly infected by HUS?
Under 16 years old
25
In HUS what are the white cells like, platelets, Hb, LDH?
High WWC
Low platelets
Low Hb
LDH > 1.5 x normal
26
How is HUS investigated?
Send stool culture samples for all bloody diarrhoea samples
27
Other than U&S, FBC, film, LFT, clotting what else would you send for?
Urine (dipstick/micro)
Lactate dehydrogenase
28
What are three complications of HUS?
1. Acute renal failure
2. Thrombocytopaenia
3. Haemolytic anaemia
29
What 3 drug types are NOT given in HUS?
1. Antibiotics
2. Anti-motility agents
3. NSAIDS
30
What kind of diagnosis are these factors involved in: selective culture, sorbitol non fermenter, E coli isolated, check for O157 antigen?
Microbiological diagnosis
31
What infection is associated with contacting farm animals and private drinking water?
E coli O157
32
What two things must you notify the Health Protection Unit on?
Haemolytic Uraemic Syndrome or O157
33
What is the likely cause of blood diarrhoea in children and elderly?
E coli O157
34
What virus is the commonest cause in kids
Rotavirus
35
How is rotavirus transmitted?
Person-person and faecal oral
36
What is diarrhoea like in rotavirus?
Not bloody, mild and watery
37
Along with diarrhoea, what 2 other symptoms occur in rotavirus?
Vomiting and fever first
38
What is the infectious dose like in rota virus?
Low
39
How is rota virus diagnosed?
PCR diagnosis on faeces
40
What is management for rotavirus?
Hydration
41
What is the rota virus vaccine like?
Oral and live attenuated
42
What is the 'Winter Vomiting Disease'?
Norovirus
43
How is norovirus spread?
Faecal-oral/droplet routes spread, person to person or on contaminated food/water
44
What is the infectious dose like for norovirus?
Low
45
What is diarrhoea anad vomiting like in norovirus?
Explosive and sudden
46
What is the incubation for norovirus like?
Short
47
In what 2 ways is norovirus diagnosed?
1. PCR on stool takes 6 hours
2. PCR on vomit using red Copan viral swabs
48
What is the management for norovirus?
Hydration
49
What infection is a side effect on antibiotic treatment?
Cl difficile
50
What two toxins does Cl difficile produce?
Enterotoxin and cytotoxin
51
Does CI difficile produce spores?
Yes
52
Where can CI difficile cause symptoms?
In the colon
53
What infection is related to "mild, bloody pseudomembranous colitis"?
C diff
54
What patients are most likely affected with C diff?
Elderly females >65
55
What 4 factors cause a high index of suspicion for C difficile?
1. Recent antibiotics
2. Surgery
3. Hospital
4. Use of stomach acid suppressants like PPIs
56
What is the diagnosing test for C diff?
Toxin/antigen sensitive screening test: 24 hour turnaround
57
On sigmoidoscopy of C diff patient, what is seen?
Membranous lesions
Pseudomembranous colitis
58
What two types of C diff are virulent strains producing 20x more toxin and lead to aggressive disease and death?
027
078
59
What is the term for inflammation of stomach or intestines - it inhibits nutrient absorption and excessive H2O and electrolyte loss?
Gastroenteritis
60
What are 3 preformed organisms that cause food poisoning?
1. Staph auresu
2. Clostridium perfringens
3. Bacillus cereus
61
What 2 organisms cause in vivo production of toxin related food posioning?
1. Vibrio
2. Enterotoxigenic E.coli
62
What are the three clinical syndromes of acute enteritis?
1. Fever
2. Diarrhoea and vomiting
3. Abdominal pain
63
What are the three clinical syndromes of enteric fever like illness?
1. Fever
2. Rigors
3. Pain
64
What 4 organisms can cause bloody diarrhoea and usually indicate colonic inflammation?
1. Campylobacter
2. Shigella
3. E coli
4. Amoebiasis
65
What is a rare, but important complication of Campylobacter?
Guillain-Barre
66
What can severe cases of campylobacter be treated with?
Clarithromycin or azithromycin
67
What condition involves tingling of the feet, leading to progressive paralysis of the legs, arms and rest of body?
Guillain-Barre Syndrome
68
What type of fever is typhoid?
Enteric fever
69
What type of enteric fever is imported from India, SE Asia, Far East, Middle East and Africa?
Typhoid
70
What two ways is typhoid transmitted?
Food and water
Carrier
71
What are the 3 features of presentation of typhoid?
1. Asymptomatic. mild
2. Bacteraemia
3. Enterocolitis
72
What is key to diagnosis of typhoid, but what can also be done to help?
Blood cultures
Stool and urine culture
73
What 4 antibiotics are used to treat Tyhpoid?
1. Chloramphenicol and Ciprofloxacin
2. Ceftriaxone or azithromycin
74
What two infections require an in depth travel history?
Giardia
Amoeba
75
What investigation would be done for Salmonella, Campylobacter and Shigella?
Stool culture
76
What two infections require toxin testing?
E Coli
C. difficle
77
What organism would you do a blood culture for?
Salmonella
78
What is creatinine like in C.diff?
>1.5 x baseline
79
What four factors are severity markers of C.diff?
1. Pseuodemembranous colitis
2. Toxic megacolon
3. Ileus
4. Colonic dilatation >6cm
80
Give 4 complications of bacterial enteritis intestinal?
1. Severe dehydration and renal failure
2. Acute colitis, toxic dilatation
3. Post infective irritable bowel (very common)
4. Transient secondary lactase intolerance
81
What are septicaemia, meningitis, aortitis, ostyeomyelitis, endocarditis, reactive arthritis, meningism, Guillian Barre Syndrome, haemolytic uraemic syndome all complications of?
Bacterial enteritis extra-intestinal
82
Name two antimotility agents?
Opiates and loperamide
83
Name tow anti-secretory agents?
Chlorpromazine, bismuth subsalycilate
84
Name two absorbents?
Kaolin, charcoal
85
What is an anaerobic gram-positive spore forming bacillus?
C. diff
86
What are four antibiotics that are risk factors for C diff?
1. Fluoroquinolones
2. Cephalosporins
3. Clindamycins
4. Broad spectrum penicillins
87
What are two medications that can be risk factors for C diff?
1. PPI
2. H2 receptor antagonists
88
What are the 4 C. dff causing antibiotics?
1. Cephalosporins
2. Clindamycin
3. Ciprofloxacin (quinolines)
4. Clarithromycin (macrolides)
89
For pseudomembranous colitis, what drugs should be stopped and what antibiotic should be given?
Stop opiates, PPIs and anti-perstaltic drugs
Give oral vancomycin or metranidazole for non-severe cases
90
What drug is used for a relapse of c diff?
Fidaxomicin
91
What are 3 travel related diarrhoea causes?
1. Amoebiasis
2. Giardiasis
3. Cryptosporidiosis
92
What is a protozoal infection spread by faeco-oral route or by an ill or asymptomatic carrier?
Amoebiasis
93
What areas is amoebiasis com mon in?
Areas of poor sanitation
94
What is the diarrhoea like in amoebiasis?
Acute and bloody
95
How is diagnosis ofintestinal amoebiasis made?
By examination of hot stool for ova and cysts (stool M & C)
96
What is the treatment for amoebiasis?
Metronidazole. Remove from lumen by using diloxanide furate or paromomycin
97
What is the diarrhoea like in giardiasis?
Explosive, protracted and foul smelling
98
What infection is protozoan Giardia lambia trophozoites colonising the small bowel mucosa to produce diarrhoea?
Giardiasis
99
How is Giardiasis spread?
Spread by cysts found in normal drinkng water
100
How is giardiasis diagnosed?
Examine stools for ova and cysts but more accurately by duodenal aspiration.
101
How is giardiasis treated?
With metronidazole
102
What is one of the main causes of infectious diarrhoea in many parts of the world and is an important cause of travel related diarrhoea?
Cryptosporidiosis
103
How is cryptosporidiosis transmitted?
Water, food, animal contact, highly infectious and resilient
104
What patient types usually get cryptosporidiosis (C.parvum)?
West African Children
105
How is cryptosporidiosis diagnosed?
By duodenal aspirate/stool
106
How is cryptosporidiosis treated?
Supportive
107
How is diagnosis of extra-intestinal ameobiasis made?
Requires serology
108
Name two arboviruses?
Dengue
Chikungunya
109
What is the definition of acute tranveller's diarrhoea?
3 loose stools in 24 hours
110
What typically causes acute traveller's diarrhoea?
Enterotoxigenic E. coli
111
Other than E.coli, what three other causes of acute traveller's diarrhoea are there?
Campylobacter, Salmonella and Shigella
112
What is commonly caught on Cruise ships?
Noravirus or rotavirus
113
What infection is often associated with outbreaks in refugee camps?
Cholera
114
What two investigations are done for acute traveller's diarrhoea?
1. Stool culture
2. Stool wet prep on recently passed stool for amoebic trophozoites
115
What is the treatment for Acute traveller's diarrhoea?
Supportive - fluid rehydration
In travelling patients, ciprofloxaacin single dose can stop worsening
116
What is most common from travellers returning from India subcontinent or SE Asia?
Typhoid or paratyphoid fever (enteric fever)
117
Where is Salmonella typhi usually isolated from?
Blood, stool or urine
118
How is Salmonella typhi treated?
With ceftriaxone
119
What three things can be a cause of fever and pre-hepatic jaundice?
Malaria, HUS (E.coli O157/Shigella), sickle cell crisis
120
What does leptosirosis cause?
Weils disease (icteric, haemorrhagic and renal failure)
121
What is a post-hepatic cause of fever and jaundice?
Ascending cholangitis and helminths
122
How is malaria investigated?
Blood film and rapid antigen
123
What is this: incubation period 9-20 weeks, fever, cough, aching abdominal pain, hepatomegaly, sometimes a history of GI upset and usually male?
Amoebic liver abscess
124
How is amoebic liver abscess investigated?
CXR (raised right hemidiaphragm)
Abnormal LFTs, US/CT, serology,
125
What is the management for amoebic liver abscess?
Metronidazole and paramomycin/diloxanide to clear gut lumen of parasites
126
What are Helminth infections - parasites - often diagnosd by?
The adult worm passed or eggs in stool
127
What are two types of nematodes (round worms)?
Intestinal roundworms
Tissue roundworms (filariasis)
128
What are trematodes?
Flukes
129
What are cestodes?
Tapeworms
130
What is the most common helminthic infection in the world?
Ascariasis
131
What is the life-cycle of a helminth infection?
Egg ingested and hatches in small intestine. Invades gut wall into venous system and via liver and heart reaches lungs. Breaks into alveoli and ascends tracheobronchial tree then becomes swallowed. In the gut develops into adult worm where they start to produce eggs.
132
Name a trematode (fluke) and where can you get it from?
Schistosomiasis - fresh water exposure
133
What can adult worms located in portal venules lead to?
Hepatomegaly, liver fibrosis and portal hypertension
134
How can cestodes such as tapeworms Taenia solium or Saginatum, be aquired?
By eating undercooked meat containing infectious larval cysts
135
What can Taenia solium eggs cause?
Cysticercosis - tissue cysts muscle and brain
136
What protozoa is involved in Chagas disease?
Trypanasoma cruzi
137
How is Chagas disease transmitted?
By the kissing bug
138