Infectious Diarrhea Flashcards
(41 cards)
common in areas with poor sanitation
comma-shaped, gram negative
Ganges Valley of India and Bangladesh
fecal oral, water transmission, shellfish!
noninvasive! remains
has a toxin and flagella
“rice water” stools, severe watery diarrhea
Cholera
-causes diarrhea b/c the chloride, sodium, bicarb in the lumen create osmotic force that draws water into the lumen
you can get this again- there’s no immunity!!!
death can occur b/c of dehydration ! losing massive amounts of fluid
what are the complications of cholera
dehydration hypotension muscular cramping anuria shock LOC death (mostly within the first 24 hrs after presentation)
Gram negative
comma shaped
most common enteric pathogen in developed countries
causes travelers diarrhea, either bloody*** or non
flu-like prodrome with fever
ingestion of improperly cooked chicken, unpasturized milk or contaminated water
produces a toxin
can result in reactive arthritis (HLA-B27), erythema nodosum, Guillain-Barre
diagnose by stool culture
Campylobacter
what is the potential pathogenesis of Guillan Barre syndrome associated with campylobacter
Molecular mimicry has been implicated in the pathogenesis of Guillain-Barré syndrome, as serum antibodies to C. jejuni lipopolysaccharide cross-react with peripheral and central nervous system gangliosides.
treatment for campylobacter
antibiotics are not required
liquids? hydration?
gram negative , unencapsulated, non motile, facultative anaerobes
very bloody diarrhea *** with a high fever
fecal-oral route or via contaminated water and food
taken up by M cells in the intestine and eventually invade basolateral membranes
most prominent in the left colon and ileum
1 week of diarrhea that progresses to bloody diarrhea in 1/2 pt’s
can also mimic new onset ulcerative colitis
Shigellosis
self-limited disease
A 32 y/o old owner of a day care center presents with a two day history of bloody diarrhea and a fever of 102. She notes that several of the children in her center have had similar symptoms. You suspect which of the following organisms:
what are the complications of shigella infection
sterile reactive arthritis
urethritis
conjunctivitis
treatment of shigella infection
what is contraindicated in the treatment of shigella
antibiotics shorten the course and reduce duration of shedding in stool - fluoroquinolone
anti-diarrheal’s are contraindicated b/c they prolong symptoms and delay clearance
gram negative bacilli
infection most common in young children and older adults
ingestion of contaminated food, raw or undercooked meat, poultry, eggs, milk
stool culture for diagnosis
watery or bloody diarrhea
colon and small intestine
Salmonella
treatment of salmonella
antibiotic therapy not recommended b/c it can prolong the carrier state
self-limited disease
children and adolescents are affected more often
Travel to India, Mexico, Philippines, Pakistant, El Salvador, Haiti
persons to person or via food or water
enlarged peyer patches in terminal ileum
enlarged spleen
nodules in the liver
anorexia, abd pain, bloating, nausea, vomiting, bloody diarrhea
inconsistent heart rate with fever (relative bradycardia) - low heart rate compared to high fever
rose spots - chest and abdomen
Typhoid fever caused by salmonella enterica (typhi and paratyphi)
NOTE- S. typhi can disseminate via lymphatic and blood vessels
how do you treat typhoid fever
generally you don’t treat with antibiotics b/c it can prolong>
In patients who do not receive antibiotics, the initial febrile phase continues for up to 2 weeks; patients have sustained high fevers and abdominal tenderness that may mimic appendicitis.
what are the complications of typhoid fever and which patients are highly susceptible to salmonella osteomyelitis?
Systemic dissemination may cause extraintestinal complications including encephalopathy, meningitis, seizures, endocarditis, myocarditis, pneumonia, and cholecystitis.
Patients with sickle cell disease are particularly susceptible to Salmonella osteomyelitis.
abdominal pain (RLQ), fever, diarrhea
ingestion of pork, raw milk, contaminated water
Iron enhances virulence
preferentially involve the ileum, appendix and right colon
regional lymph node and peyer patch hyperplasia
bowel wall thickening
looks similar to crohn’s
extraintestinal manifestations include–> pharyngitis, arthralgia, erythema nodosum
Yersinia Enterocolitica - more common
Yersinia Pseudotuberculosis
can mimic acute appendicitis **
can be associated with sore throat and reiter’s syndrome (uveitis, arthritis,
travelers diarrhea
spread via contaminated food or water (fecal oral route)
children induce chloride and water secretion
secretory, noninflammatory diarrhea, dehydration, shock
enterotoxigenic e coli (ETEC)
can cause dehdyration and electrolyte imbalance
Diarrheal outbreaks, particularly in children < 2 years of age
cause effacement of microvilli
causes watery diarrhea
dehydration and electrolyte imbalance
enteropathogenic e coli (EPEC)
gram negative rods
bloody diarrhea
consumption of inadequately cooked ground beef, contaminated milk
shiga-like toxin
antibiotics are NOt recommended –> b/c of enhanced risk of hemolytic uremic syndrome (especially in children) b/c of release of shiga-like toxin
enterohemorrhagic e. coli
think boy scouts who at the hamburgers
transmitted via food, water or by persons-to-person contact
affect primarily young children
occurs in the colon
bloody diarrhea
more common in underdeveloped countries
enteroinvasive e coli
antibiotic associated - clindamycin
at risk are the advanced age, hospitalization, antibiotic treatment
fever, leukocytosis, abdominal pain, cramps, watery diarrhea, dehydration
hypoalbuminemia
diagnosis with toxins in stool
pseudomembranous colitis
generally caused by C. difficile
how do you treat c diff
how do you prevent the spread of this?
metronidazole first (b/c its cheaper) - make sure they don’t drink when they take this!
oral vancomycin second
Fidaxomicin
prevent the spread of this illness by…. they are able to survive by spore formation and its the lathering up/saponification that kills the spore
malabsorption, lymphadenopathy, arthritis of undetermined origin
foamy macrophages in the small intestinal lamina propria - PAS positive
most common in caucasian men, farmers
diarrhea, weight loss, arthralgia
Gram positive Tropheryma whippelii responsible for Whipple disease
Clinical symptoms occur because organism-laden macrophages accumulate within the small intestinal lamina propria and mesenteric lymph nodes, causing lymphatic obstruction. Thus, the malabsorptive diarrhea of Whipple disease is due to impaired lymphatic transport.
why would someone have bleeding from foley catheters and injection sites as well as some minor bloody diarrhea if they have c. diff
vitamin K deficiency from malabsorption
most humans get vitamin K from gut bacteria
bacteria in the gut provide vitamin K supply- wipe out the bacteria (b/c of multiple antibiotics) you get prone to bleeding (clotting factors that lack vitamin K)
contaminated food, water and person to person transmission
Bloody diarrhea
cruise ships and dorms
kills many children per year
adults and kids are affected!
High fever, abdominal pain, and sore throats can be associated with this
norovirus
how do you make the diagnosis of c. diff
toxin in stool
PCR?
