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Infectious Diarrhoea Flashcards

(44 cards)

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1
Q

What is definition of gastro-enteritis?

A

3+ stools in 24 hrs PLUS one of fever, vomit, pain, blood/mucus stool

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2
Q

What is dysentery?

A

Large bowel inflammation + bloody stools

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3
Q

What are causative mechanisms of diarrhoea?

A

Toxins, invasion, others

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4
Q

What are defences against diarrhoea?

A

Age, hygiene, gastric acid, gut motility, gut immunity, normal flora

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5
Q

What are the 3 types of diarrhoea?

A

Non-inflammatory, Inflammatory, Mixed

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6
Q

What is non-inflammatory (secretory) diarrhoea? What is the treatment?

A

Toxin mediated
Watery stools, rapid dehydration
Tx = rehydration

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7
Q

What is inflammatory diarrhoea?

Treatment?

A

Bacterial infection
Inflammatory + toxin damage and mucosal destruction
Causes abdominal pain, fever, bloody stools, systemic upset
Tx = rehydration +/- antimicrobials

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8
Q

What is an example mixed diarrhoea?

A

C. difficile

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9
Q

What is the most common bacterial pathogen causing diarrhoea

A

Campylobacter

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10
Q

What pathogen causes the most hospital admissions due to diarrhoea?

A

Salmonella

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11
Q

Causes of infectious diarrhoea?

A

Contamination of foodstuffs e.g. chicken, poor food storage, travel related, person-to-person transmission

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12
Q

Patient assessment, what symptoms do you ask about?

A

Duration, frequency, consistency of diarrhoea

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13
Q

What risk factors are there for diarrhoea?

A

Food poisoning, occupation, travel, antimicrobials

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14
Q

What do you check on examination of a patient with diarrhoea?

A

Hydration status- BP, pulse, urine flow, skin turgor, muscle cramps

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15
Q

What are features of inflammation on a patient?

A

Fever, raised WCC

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16
Q

When is gastro-enteritis unlikely?

A

If diarrhoea present for over 2 weeks

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17
Q

What consequences are there due to fluid + electrolyte loss?

A

Severe dehydration (1-7 litres of fluid lost per day)
Hyponatraemia (sodium loss during fluid replacement with hypotonic solutions)
Hypokalaemia ( K+ loss in stool)

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18
Q

What investigations should be done?

Study These Flashcards
A

Stool + blood culture, blood count (neutrophilia, haemolysis), renal function, sigmoidoscopy, abdo x-ray if distended, serology

19
Q

Differential diagnosis?

Study These Flashcards
A

Diarrhoea as a response to sepsis
IBD (duration > 2 weeks)
Spurious diarrhoea secondary to constipation
Carcinoma

20
Q

Treatment for diarrhoea?

Study These Flashcards
A 
Oral rehydration - with salt / sugar
IV saline
Antimicrobials
Fasting
Treat complications
21
Q

What are the features of campylobacter infection? (C. jejuni)

Study These Flashcards
A

Incubation of up to 7 days, infection clears within 3 weeks (but can have positive stool test up to 6 weeks0
SEVERE abdo pain, +/- colitic picture
Rarely invasive
Post invective sequelae: Guillain barre syndorme, Reactive arthritis

22
Q

What are the features of salmonella infection?

Study These Flashcards
A 
Symptom onset <48 h after exposure
Diarrhoea lasts < 10 days
<5% have positive blood culture
20% have positive stools at 20 weeks
27% experience IBS symptoms 6 months after
23
Q

What are the features of E.Coli 0157?

Study These Flashcards
A

Infection from e.g. contaminated meat/ Cattle reservoir
Frequent bloody stools
Produce a shiga-like toxin (SLT)
E. coli O157 stays in the gut but the toxin gets into the blood
Enterohaemorrhagic: haemorrhage within intestines

24
Q

What toxin can cause HUS and what is HUS?

Study These Flashcards
A

The shiga like toxin (SLT)
HUS = Haemolytic uremic syndrome
Causes haemolytic anaemia (caused by destruction of blood cells) + acute renal failure

25
What are the features of Shigella?
largely a childhood / travel disease HUS and seizures can complicate it Different serotypes set back development of a vaccine for Shigella
26
What other forms of E. Coli cause diarrhoea?
enteropathogenic enterotoxic enteroinvasive
27
What bacterial pathogens cause food poisoning?
Stap aureus Bacillus cereus Clostridium perfringens
28
What are the main pathogens of traveller's diarrhoea?
Enterotoxigenic E. coli, campylobacter, shigella
29
How are parasites diagnosed?
By microscopy + PCO (parasites, cysts and ova tests)
30
Describe the features of rotavirus + its diagnosis?
Common in winter + children <5 years Diagnosis by antigen detection (note: Rotavirus vaccine used in developing world)
31
Describe the features of norovirus? | How is it diagnosed?
Faecal-oral transmission winter vomiting disease VERY infectious, common cause of outbreaks in hospitals + cruise ships Diagnosis: PCR
32
Give two examples of intestinal parasites
Cryptosporidiosis | Giardia Lamblia
33
What are the features of cryptosporidiosis?
Caused by water-borne outbreaks (cattle = principal reservoir) Cysts seems on microscopy Self limiting, No Tx
34
What are the features of Giardia Lamblia?
present in contaminated water causes diarrhoea, malabsorption, failure to thrive Cysts seen on microscopy Tx = metronidazole, tinidazole
35
Give an example of an imported parasite + describe its features
``` Entamoeba histolytica = Amoebic dysentery Cysts seen in asymptomatic patient Long term Cx= amoebic liver abscess Microscopy only 50% sensitive May mimic Ulcerative Colitis ```
36
What is the treatment for Amoebic dysentery?
10 days of metronidazole
37
What is an antibiotic associated diarrhoea?
Clostridium difficile infection
38
Describe the features of a Clostridium difficile infection (CDI)
Overgrowth of C. diff + production of toxins A (enterotoxin) and toxin B (cytotoxin)
39
What are the symptoms of a CDI?
Severity ranges from mild diarrhoea to severe colitis
40
What are the investigations for CDI?
Sigmoidoscopy, stool culture, toxin detection (33% false negative)
41
What is the treatment for CDI?
1. Metronidazole 2. Oral vancomycin (give if 2 or more severity markers) 3. Fidaxomicin
42
How do you prevent CDI?
Reduction in broad spectrum antibiotics prescribing Avoid the 4 C's: Cephalosporins, co-amoxiclav, clindamycin, clarithromycin Isolate symptomatic patients Prevention with biotherapy
43
For what pathogens are routine bacterial cultures done?
Campylobacter + Salmonella
44
What indications are there for giving antibiotics?
Immunocompromised patients, severe sepsis, valvular heart disease, diabetes, chronic illness

Infection (12 decks)

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