Infectious colitis

Question 1

What is Campylobacter?

Answer 1

Campylobacter is the commonest bacterial cause of infectious intestinal disease in the UK.

Question 2

What is the most common species of Campylobacter?

Answer 2

The majority of cases are caused by the Gram-negative bacillus Campylobacter jejuni.

Question 3

How is Campylobacter spread?

Answer 3

It is spread by the faecal-oral route.

Question 4

What is the incubation period for Campylobacter?

Answer 4

The incubation period is 1-6 days.

Question 5

What are the prodromal symptoms of Campylobacter infection?

Answer 5

Prodrome includes headache and malaise.

Question 6

What are the common symptoms of Campylobacter infection?

Answer 6

Symptoms include often bloody diarrhoea and abdominal pain that may mimic appendicitis.

Question 7

What is the management for Campylobacter infection?

Answer 7

It is usually self-limiting; treatment is advised if severe or if the patient is immunocompromised.

Question 8

When are antibiotics recommended for Campylobacter infection?

Answer 8

Antibiotics are recommended if severe symptoms or symptoms have lasted more than one week.

Question 9

What is the first-line antibiotic for Campylobacter infection?

Answer 9

The first-line antibiotic is clarithromycin.

Question 10

What is an alternative antibiotic for Campylobacter infection?

Answer 10

Ciprofloxacin is an alternative, but strains with decreased sensitivity are frequently isolated.

Question 11

What are some complications of Campylobacter jejuni infections?

Answer 11

Complications may include Guillain-Barre syndrome, reactive arthritis, septicaemia, endocarditis, and arthritis.

Question 12

What is Clostridioides difficile?

Answer 12

Clostridioides difficile is a Gram positive rod often encountered in hospital practice.

Question 13

What syndrome does Clostridioides difficile cause?

Answer 13

It causes intestinal damage leading to a syndrome called pseudomembranous colitis.

Question 14

What leads to the development of C. difficile?

Answer 14

C. difficile develops when the normal gut flora are suppressed by broad-spectrum antibiotics.

Question 15

Which antibiotics are historically associated with causing C. difficile?

Answer 15

Clindamycin is historically associated, but second and third-generation cephalosporins are now the leading cause.

Question 16

What are other risk factors for C. difficile infection?

Answer 16

Other than antibiotics, proton pump inhibitors are a risk factor.

Question 17

What is the pathophysiology of C. difficile?

Answer 17

It is an anaerobic gram-positive, spore-forming, toxin-producing bacillus that transmits via the faecal-oral route.

Question 18

What toxins does C. difficile release?

Answer 18

It releases two exotoxins, toxin A and toxin B, that act on intestinal epithelial and inflammatory cells.

Question 19

What are the common features of C. difficile infection?

Answer 19

Common features include diarrhoea, abdominal pain, and a raised white blood cell count (WCC).

Question 20

What severe condition may develop from C. difficile infection?

Answer 20

If severe, toxic megacolon may develop.

Question 21

What is the Public Health England severity scale used for?

Answer 21

It is used to determine the severity of C. difficile infection for treatment purposes.

Question 22

What characterizes mild C. difficile infection?

Answer 22

Normal WCC and typically 3-5 loose stools per day.

Question 23

What characterizes moderate C. difficile infection?

Answer 23

Increased WCC (< 15 x 10^9/L).

Question 24

What characterizes severe C. difficile infection?

Answer 24

Increased WCC (> 15 x 10^9/L) or evidence of severe colitis.

Question 25

What characterizes life-threatening C. difficile infection?

Answer 25

Hypotension, partial or complete ileus, or toxic megacolon.

Question 26

How is C. difficile diagnosed?

Answer 26

Diagnosis is made by detecting C. difficile toxin (CDT) in the stool.

Question 27

What does C. difficile antigen positivity indicate?

Answer 27

It shows exposure to the bacteria, rather than current infection.

Question 28

What is the first-line therapy for the first episode of C. difficile infection?

Answer 28

Oral vancomycin for 10 days.

Question 29

What is the second-line therapy for the first episode of C. difficile infection?

Answer 29

Oral fidaxomicin.

Question 30

What is the third-line therapy for the first episode of C. difficile infection?

Answer 30

Oral vancomycin +/- IV metronidazole.

Question 31

What is the recurrence rate of C. difficile infection?

Answer 31

Recurrent infection occurs in around 20% of patients, increasing to 50% after their second episode.

Question 32

What is the treatment for recurrent C. difficile infection within 12 weeks of symptom resolution?

Answer 32

Oral fidaxomicin.

Question 33

What is the treatment for recurrent C. difficile infection after 12 weeks of symptom resolution?

Answer 33

Oral vancomycin OR fidaxomicin.

Question 34

What is the treatment for life-threatening C. difficile infection?

Answer 34

Oral vancomycin AND IV metronidazole with specialist advice for possible surgery.

Question 35

What is bezlotoxumab?

Answer 35

Bezlotoxumab is a monoclonal antibody that targets C. difficile toxin B.

Question 36

What is the current stance of NICE on bezlotoxumab?

Answer 36

NICE does not currently support its use to prevent recurrences as it is not cost-effective.

Question 37

What is a potential therapy for patients with multiple previous episodes of C. difficile?

Answer 37

Faecal microbiota transplant may be considered.

Question 38

What is essential for preventing the spread of C. difficile infection?

Answer 38

Isolation in a side room until no diarrhoea for at least 48 hours, and staff should wear gloves and aprons.

Question 39

What is crucial for hygiene in C. difficile infection prevention?

Answer 39

Hand washing is essential; alcohol gel does not kill C. difficile spores.

Question 40

What is gastroenteritis?

Answer 40

Gastroenteritis is an inflammation of the stomach and intestines, which can occur at home or while traveling abroad.

Question 41

What defines travellers' diarrhoea?

Answer 41

Travellers' diarrhoea is defined as at least 3 loose to watery stools in 24 hours, with or without abdominal cramps, fever, nausea, vomiting, or blood in the stool. ## Footnote The most common cause is Escherichia coli.

Question 42

What is acute food poisoning?

Answer 42

Acute food poisoning describes the sudden onset of nausea, vomiting, and diarrhoea after ingesting a toxin.

Question 43

What are common causes of acute food poisoning?

Answer 43

Common causes include Staphylococcus aureus, Bacillus cereus, and Clostridium perfringens.

Question 44

What is the typical presentation for Escherichia coli infection?

Answer 44

Common amongst travellers, it presents with watery stools, abdominal cramps, and nausea.

Question 45

What is the typical presentation for Giardiasis?

Answer 45

Giardiasis typically presents with prolonged, non-bloody diarrhoea.

Question 46

What is the typical presentation for Cholera?

Answer 46

Cholera presents with profuse, watery diarrhoea and severe dehydration resulting in weight loss. ## Footnote Not common amongst travellers.

Question 47

What is the typical presentation for Shigella infection?

Answer 47

Shigella infection presents with bloody diarrhoea, vomiting, and abdominal pain.

Question 48

What is the typical presentation for Staphylococcus aureus infection?

Answer 48

Staphylococcus aureus infection is characterized by severe vomiting and a short incubation period.

Question 49

What is the typical presentation for Campylobacter infection?

Answer 49

Campylobacter infection usually starts with a flu-like prodrome, followed by crampy abdominal pains, fever, and diarrhoea, which may be bloody.

Question 50

What are the complications associated with Campylobacter infection?

Answer 50

Complications can include Guillain-Barre syndrome.

Question 51

What are the two types of illness caused by Bacillus cereus?

Answer 51

Bacillus cereus can cause vomiting within 6 hours (typically due to rice) and diarrhoeal illness occurring after 6 hours.

Question 52

What is the typical presentation for Amoebiasis?

Answer 52

Amoebiasis presents with gradual onset bloody diarrhoea, abdominal pain, and tenderness that may last for several weeks.

Question 53

What are the incubation periods for Staphylococcus aureus and Bacillus cereus?

Answer 53

The incubation period is 1-6 hours for Staphylococcus aureus and Bacillus cereus (vomiting subtype). ## Footnote The diarrhoeal illness has an incubation period of 6-14 hours.

Question 54

What are the incubation periods for Salmonella and Escherichia coli?

Answer 54

The incubation period for Salmonella and Escherichia coli is 12-48 hours.

Question 55

What are the incubation periods for Shigella and Campylobacter?

Answer 55

The incubation period for Shigella and Campylobacter is 48-72 hours.

Question 56

What are the incubation periods for Giardiasis and Amoebiasis?

Answer 56

The incubation period for Giardiasis and Amoebiasis is greater than 7 days.

Question 57

What type of bacteria is the Salmonella group?

Answer 57

The Salmonella group contains aerobic, Gram-negative rods.

Question 58

Are Salmonella normally present as commensals in the gut?

Answer 58

No, they are not normally present as commensals in the gut.

Question 59

What causes typhoid and paratyphoid fevers?

Answer 59

Typhoid is caused by Salmonella typhi and paratyphoid by Salmonella paratyphi (types A, B & C).

Question 60

What are the systemic symptoms of enteric fevers?

Answer 60

Systemic symptoms include headache, fever, and arthralgia.

Question 61

Which serotypes are common causes of bacterial gastroenteritis?

Answer 61

Salmonella enteritidis and Salmonella typhimurium are common causes.

Question 62

What is a common source of non-typhoidal Salmonella infections?

Answer 62

The source is often poultry, such as chicken or eggs.

Question 63

What are the features of non-typhoidal Salmonella infection?

Answer 63

Features include diarrhoea, nausea and vomiting, abdominal cramps, fever, and lethargy.

Question 64

What does Shigella cause?

Answer 64

Shigella causes diarrhoea (which may be bloody) and abdominal pain.

Question 65

How does the severity of Shigella infection vary?

Answer 65

Severity depends on the type: S. sonnei (e.g. from the UK) may be mild, while S. flexneri or S. dysenteriae from abroad may cause severe disease.

Question 66

Is Shigella infection usually self-limiting?

Answer 66

Yes, Shigella infection is usually self-limiting and does not require antibiotic treatment.

Question 67

When are antibiotics indicated for Shigella infection?

Answer 67

Antibiotics (e.g. ciprofloxacin) are indicated for people with severe disease, who are immunocompromised, or with bloody diarrhoea.

Question 68

Clostridioides difficile Public Health England severity scale

Answer 68

Question 69

Answer 69

Question 70

gastroenteritis infections & presentations

Answer 70

Question 71

gastroenteritis: infections & presentations

Answer 71