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Clin Med semester 2 > Infections of GI tract: Infectious Diarrhea-Schoenwald- Exam 3 > Flashcards

Infections of GI tract: Infectious Diarrhea-Schoenwald- Exam 3 Flashcards

1
Q

Infectious Diarrhea:

  • onset?
  • MC outbreaks?
  • What hx do you need from the Pt?
A
  • Acute in onset and lasting <2 weeks
  • Community outbreaks (nursing homes, schools, cruise ships) suggest viral etiology or common food source
  • Get travel history
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2
Q

Noninflammatory Diarrhea= watery, ________ diarrhea

A

nonbloody

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3
Q

Noninflammatory diarrhea:

  • associated Sx?
  • disrupts?
A
  • Associated with cramping, bloating, nausea, vomiting

- Disrupts normal absorption in small bowel

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4
Q

T/F: In Noninflammatory diarrhea Tissue invasion does not occur.

-NO _____ _______ on smear

A

True! Tissue invasion does not occur-no fecal leukocytes on smear

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5
Q

Inflammatory Diarrhea= fever and _____ diarrhea

A

bloody

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6
Q

Inflammatory Diarrhea:

-causes ______ tissue damage

A

colonic

invasion of bacteria or toxin

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7
Q

Inflammatory diarrhea:

involves primarily the _____ colon

A

lower colon–>left lower quadrant cramping, urgency

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8
Q

Inflammatory Diarrhea:

-fecal ________ present because of invasion of mucosa

A

fecal leukocytes

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9
Q

DDx for inflammatory diarrhea

A

ulcerative colitis

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10
Q

Inflammatory diarrhea:

-Diarrhea >14 days most likely NOT due to _______ agent

A

infectious agent (except C diff)

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11
Q

Why do we classify as inflammatory or noninflammatory diarrhea?

A
  • Major difference is colonic tissue invasion by the organism and/or toxin
  • Helps to differentiate when it is “okay” to use promotility agents-Imodium
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12
Q

DO NOT use ______ agents in inflammatory diarrhea

A

promotility

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13
Q

Typical Stool Pathogens

A
  • Salmonella
  • Shigella
  • Campylobacter
  • Vibrio
  • E coli O157:H7
  • Clostridium diff: pseudomembranous colitis
  • Norovirus
  • Enterovirus
  • Parasites-Giardia, Amoeba, Cyptosporidium
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14
Q

Causes of Acute Infectious Diarrhea: Noninflammatory (list examples)

A
  • Enterotoxin production
  • Norovirus
  • Rotavirus
  • Giardia
  • Cryptosporidium
  • Listeria monocytogenes
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15
Q

Acute infectious diarrhea:

-list the pathogens that are specifically associated with enterotoxin production (4 of them)

A

Staph aureus
Bacillus cereus
Enterotoxigenic E coli
Vibrio cholerae

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16
Q

Causes of Acute Infectious Diarrhea: inflammatory (list examples)

A
  • Cytotoxin production
  • Mucosal invasion
  • Cytomegalovirus
  • Entamoeba histolytica
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17
Q

Acute Infectious Diarrhea: inflammatory

-list the specific organisms associated with Cytotoxin production

A
  • Enterohemorrhagic E coli 0157:H7

- Clostridium difficile

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18
Q

Acute Infectious Diarrhea: inflammatory

-list the specific organisms associated with Mucosal invasion

A
  • Campylobacter
  • Shigella
  • Salmonella

“think-> invasion “make camp” (=campylobacter and make salmon (salmonaella)

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19
Q

Inflammatory Diarrheas:

-(list 5)

A
  • Clostridioides difficile (new name)–>Previously Clostridium difficile
  • Salmonella
  • Shigella
  • Campylobacter
  • Escherichia coli 0157:H7
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20
Q

Clostridioides difficile (Clostridium difficile):

  • main Sx is _____
  • major risk factors?
A
  • diarrhea
  • Previous antibiotic usage(historically **clindamycin, penicillins and cephalosporins)
  • Advanced age
  • Previous hospitalization
  • Nursing home resident
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21
Q

C difficile– the new definition:

  • Presence of which Sx?
  • incidence has _____ from 2000-2005
A
  • CDI-C diff infection
  • Presence of Sx in the form of 3 or more unformed stool over 24 hours for 2 consecutive days in conjunction with positive stools for pseudomembranes
  • Prior antimicrobial use not included in new guidelines
  • Incidence had tripled from 2000-2005
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22
Q

C difficile:

  • clinical findings?
  • _____ diarrhea
  • ____ bowel movements per day
  • fever present?
  • Can lead to _____ _____ and colectomy
A
  • **Watery diarrhea
  • 15-30 bowel movements/day
  • Abdominal pain or cramps
  • Fever-low grade
  • *Can lead to toxic megacolon and colectomy
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23
Q

C diff-lab findings

A
  • Leukocytosis-often with bandemia (**left shift)
  • Hypoalbuminemia
  • *Positive stool C diff test
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24
Q

Lab Tests for C diff:

-list 3

A
  • Molecular test-PCR
  • –Highly sensitive and specific
  • –Can be positive in asymptomatic patients
  • Antigen detection–> nonspecific
  • Toxin testing: Toxin A and B testing –high rate of false negatives

(do toxin testing first, if that’s negative, follow-up w/ PCR)

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25
Q

Initial Episode of C diff: mild/moderate
-leukocytosis?
-Creatine ?
Tx?

A

Leukocytosis <15000,Creat <1.5

tx: Vancomycin 125 mg po qid x 10 days OR Fidaxamin 200 mg po bid x 10 days
note: fidaxamin is expensive!!

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26
Q

Initial Episode of C diff: Severe
-leukocytosis?
-Creat.?
Tx?

A

Leukocytosis >15000, Creat >1.5 prior to CDI

tx:Vancomycin 125 mg po qid x 10 days OR fidaxamin 200 mg po bid x 10 days

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27
Q

Initial Episode of C diff: complicated
-sx?
Tx?

A

Hypotension or shock,perforation, megacolon

tx: Vancomycin 500 mg po qid or via NG tube and/or metronidazole 500-750 mg IV q 8 hrs

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28
Q

C diff: 1st recurrence

tx?

A

Vancomycin oral taper or Fidaxamin

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29
Q

C diff: 2nd recurrence

tx?

A

Vancomycin oral taper or Fidaxamin

-Fecal microbiota transplant

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30
Q

C diff prevention (2 main things):

  • antibiotic _______
  • Environmental _____ and hand hygiene
  • Spores can live up to __ months on a surface
A
  1. Antibiotic stewardship
  2. Environmental control and hand hygiene
    - -Spores can live up to 5 months on a surface
    - -Health care worker important vector
    - -Alcohol hand preps ineffective
    - -For surfaces, chlorine based disinfectants effective
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31
Q

Salmonella”

  • a gram _____ rod
  • carried in the ___
A
  • gram negative rod, Salmonella enteriditis

- Carried in GI tract of reptiles, bird

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32
Q

Salmonella:

  • ____ million cases per yr in US
  • most cases occur from?
A
  • 3.7 million cases
  • Most cases occur from eating contaminated meat or eggs or from infected food handlers
  • Also associated with handling reptiles
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33
Q

Salmonella:

  • Pts can remain culture positive for __ month(s) after treatment
  • incubation period=
A
  • 1 month after treatment–> can be long term carrier

- -Incubation 6-48 hrs

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34
Q

Salmonella:

  • clinical sx?
  • T/F: bloody stools are common
A
  • Fever and diarrhea MC Sx
  • Usually self limited
  • Bloody stools uncommon
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35
Q

Salmonella:
______ up to 4% of time in previously healthy with gastroenteritis
-Metastatic spread to _____

A
  • bacteremia

- Metastatic spread to vascular grafts, joints, kidneys and liver common in bacteremic patients

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36
Q

Salmonella: tx

A
  • Most cases self limiting- if uncomplicated, no Abx
  • **Ciprofloxacin= of choice,
  • Bactrim (Trimeth/Sulfa) alternate
37
Q

Typhoid fever:

  • ______ typhi
  • High risk areas?
A
  • Salmonella typhi

- High risk areas- India, Pakistan, Caribbean, Mexico

38
Q

T/F: typhoid fever is endemic to the US

A

NOT endemic to US-travel history vital for dx

39
Q

Typhoid fever: transmitted by?

A
  • contaminated food, sewage, and infected food handlers

- may be asymptomatic

40
Q

Typhoid fever:

  • Sx
  • what is the key Sx (hint: skin rash)
A 
Diarrhea
Constipation
Skin rash on torso and back-rose colored
Fever
Abdominal pain
Weakness
(Note: ppl can die from typhoid fever)
41
Q

Typhoid fever:

  • dx?
  • tx?
A
  • mainly clinical suspicion & use travel hx
  • tx: Resistance to Abx is an issue
  • Historic treatment is Fluoroquinolone-Cipro
  • Ceftriaxone resistance is developing
  • Due to resistance issues, current recommended tx is **Azithromycin for mild cases, **Carbapenems for more severe especially in cases with history of travel to SE Asia
42
Q

Typhoid Fever:

-prognosis?

A

=Serious infection

  • Can be fatal
  • -Especially if ineffective treatment due to antimicrobial resistance issues.
43
Q

Shigella is a gram _____ rod

A

negative

-“dysentery”

44
Q

Shigella:

  • ______ carriers
  • how is the infections spread?
A

-Asymptomatic carriers
-Virulent: 10-100 organisms can cause infection; person to person spread
-Worldwide distribution 650,000 deaths per year in world
-Fecal oral spread, also flies and inanimate objects
(Linked to day care centers!!! Changing diapers and poor hand washing or a kid is a carrier of shigella it can spread )

45
Q

Shigella:

-incubation period=

A

12 hours to 4 days

46
Q

Shigella: Sx

A
  • Diarrhea (bloody, watery, pus and mucus)-secretory
  • Fever
  • Stomach cramps
  • Nausea
  • Vomiting
  • dehydration
47
Q

Shigella: ddx

A

-Other bacterial infections-Vibrio
Viral
Parasites

48
Q

Shigella: tx

A
  • Rehydration
  • Ciprofloxacin= 1st line tx
  • Bactrim or Azithromycin alternate–> Recent strains show high rate of resistance
49
Q

Campylobacter:

  • a gram ______ rod
  • associated with which foods?
A

negative

-Sausages and hard meats, undercooked chicken

50
Q

Campylobacter:

  • Prodrome Sx?
  • other sx?
A
  • Often have prodrome-fever, headache, myalgia and malaise
  • Abdominal pain
  • Diarrhea
  • Fever
  • Symptoms often low grade
51
Q

Campylobacter: tx?

A
  • Ciprofloxacin drug of choice

- Azithromycin alternate

52
Q

Campylobacter: complications?

A
  • Bacteremia in <1%
  • Guillain Barre’ association (ascending paralysis)
  • Reactive arthritis
53
Q

Pathogenic E coli infections:

-Enterotoxigenic:

A

Shiga toxin + or - non 0157 strains ~80% of traveler’s diarrhea

54
Q

Pathogenic E coli infections

Enterohemmorhagic:

A

Enterohemmorhagic-shiga toxin 0157 strains:

-E coli 0157:H7–> associated with Hemolytic uremic syndrome (HUS)

55
Q

E coli 0157:H7-

  • is the main cause of ______
  • linked to _____?
  • Sx?
A
  • HUS in US
  • Linked to undercooked ground beef, drinking of unpasteurized juices and milk, working with cattle (1% of cattle in US carry)
  • Sx-bloody diarrhea, severe cramping, fever 0-30% of time, nausea/vomiting
56
Q

Hemolytic Uremic Syndrome”

-is characterized by acute renal sufficiency, hemolytic anemia, and _________

A

thrombocytopenia

57
Q

HUS:

-severe in which demographic?

A

Severe in children and elderly

Can be fatal

58
Q

HUS:

-________ test differentiates TTP from HUS

A

ADAMS 13 test

–if +, you know it’s TTP

59
Q

HUS: labs

A 
Culture often negative
Anemia
Decreased haptoglobin and increased LDH
Negative coomb’s
Thrombocytopenia
Elevated creatinine
Hematuria, proteinuria
60
Q

HUS: tx

A
  • Supportive
  • Antibiotic use controversial
  • 5-20% mortality
61
Q

Non inflammatory Diarrheas:

-list ex’s

A 
Staph Toxin
Bacillus Cereus
Listeria monocytogenes
Enterotoxigenic E coli
Vibrio cholera
Norovirus
Protozoal infections-giardia, amoeba
62
Q

Staph food poisoning:

-is from _____ NOT bacteria

A

toxin

63
Q

Staph food poisoning is more common in foos with high _____ or sugar

A

salt! (cream sauces, custard, hams, canned meat)

64
Q

Staph food poisoning:

  • onset?
  • Sx?
A

-Rapid onset 4-8 hrs

Sx: Cramping, diarrhea, nausea and vomiting

-Usually self limiting-abx not indicated

65
Q

Listeria monocytogenes:
is typically ________
-which demographic is more susceptible to infection?

A
  • foodborne
  • Pregnancy (spontaneous abortion and sepsis) and immunosuppressed more susceptible to infection
  • -Bacteremia and meningitis
66
Q

Listeria is a gram _____ bacillus

A

positive

67
Q

Listeria:

  • previous ________ use is predisposing risk factor
  • of pregnancy related cases, ___% end in fetal death
A
  • corticosteroid use

- 22% end in fetal death

68
Q

Listeria:

  • Sx?
  • tx?
A
  • Symptoms can include fever, muscle aches, headache, stiff neck, confusion
  • Tx: Ampicillin is treatment of choice–>Crosses blood brain barrier to treat meningitis
69
Q

Enterotoxigenic E coli is NOT _____

A

O157:H7

70
Q

Enterotoxigenic E coli is usually less severe when compared to ______ infection

A

0157

71
Q

Enterotoxigenic E coli:

  • is the main cause of _____
  • _____ toxin producers
A
  • traveler’s diarrhea

- Can be shiga toxin producers

72
Q

Enterotoxigenic E coli:
sx?
dx?

A

Sx: Profuse diarrhea, fever, usually not bloody, abdominal cramping

-Diagnose by stool culture or PCR

73
Q

Enterotoxigenic E coli:

-tx options?

A
  • Cipro 500 mg po bid x 7 days- 1st line
  • Trimeth/sulfa 180/800 mg po bid x 7 days
  • Azithromycin 250 mg 2 po on day 1 then 1 po day 2-5

(Maybe they cant tolerate fluoroquinolones— 2nd line = trimeth/sulfa or azithromycin )

74
Q

Vibrio cholera:

  • organism?
  • etiology?
  • incubation period?
A
  • Cholera
  • *Waterborne–>Poor water sanitation or *Shellfish
  • 12-72 hrs after ingestion
75
Q

Vibrio Cholera is an enterotoxin resulting in ______

A

massive secretion from small bowel

76
Q

Vibrio Cholera:

  • Sx? (characteristic Sx?**)
  • mortality %?
A

Sx:

  • Rapid dehydration-profuse watery diarrhea-lose 1-3 liters per day up to 20 liters per day
  • **“rice water stools”
  • Fever is rare

-1-10% mortality

(notes:Can lose up to 20 L per day— can DIE from dehydration very quickly
“rice water stool”= THINK cholera)

77
Q

Vibrio Cholera:

-tx?

A

-HYDRATION,HYDRATION,HYDRATION

-Doxycycline or Ciprofloxacin:
Can limit duration of disease but dehydration is the main issue

78
Q

Viral Gastroenteritis= inflammation of the _____

-_____ million cases per year

A
  • stomach and intestinal tract

- 211-375 million cases each year

79
Q

Viral Gastroenteritis:

  • onset?
  • Sx?
A
  • Sudden onset and rapid resolution

- Sx: Manifests clinically with diarrhea, nausea, vomiting, and stomach cramping

80
Q

Enterotoxigenic E coli is usually less severe when compared to ______ infection

A

0157

81
Q

Enterotoxigenic E coli is NOT _____

A

O157:H7

82
Q

Norovirus is the MC cause for ______

A

nonbacterial acute gastroenteritis

83
Q

Norovirus:

  • persist in what environment?
  • Outbreaks commonly occur in?
A

-Persist in environment and are hard to eradicate

  • Sporadic or epidemic
  • –Outbreaks commonly occur in nursing homes, hospitals, schools, day care, military bases, cruise ships and hotels
84
Q

Norovirus:

-transmission:

A
  • Transmission-person to person contact, contaminated food and water, airborne
  • small dose leads to infection
85
Q

Norovirus:

-how long are Pts contagious?

A

-Contagious even after symptoms resolve, may shed up to several weeks

86
Q

Norovirus:
clinical Sx?
tx?

A
  • Sudden onset vomiting or diarrhea
  • Nausea
  • Fever
  • Abdominal cramping
  • 1-3 days
  • Self limiting

-Supportive treatment

87
Q

Norovirus:

prevention?

A
  • Hand washing for at least 20 seconds with soap and water
  • Decontamination of surfaces with bleach 10%
  • Infected food handlers away from work for 48-72 hours after symptoms resolve
88
Q

Diarrheal illnesses: PEARLS

A

-Fever IS NOT always present in diarrheal illnesses

-Caution when using anti diarrheal meds and antimotility agents–Consider inflammatory vs non-inflammatory criteria
(Do not want to use antidiarrheals in Inflammatory diarrheas cuz you will likely worsen their sx and worsen the infection. But you can use these agents in non inflammatory diarrheas)

89
Q

Diarrheal illnesses: PEARLS

A
  • Fever not always present in diarrheal illnesses

- Caution when using anti diarrheal meds and antimotility agents–Consider inflammatory vs non-inflammatory criteria

Clin Med semester 2 (24 decks)

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