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Infectious diarrhoea Flashcards

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1
Q

What is the objective definition of gastro-enteritis?

A

Three or more loose stools/day

Accompanying features

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2
Q

What are the obvious features of dysentery?

A

Large bowl inflammation

Bloody stools

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3
Q

What are examples of the epidemiology of gastro-enteritis?

A

Contamination of foodstuffs - chicken and campylobacter
Poor storage of produce - bacterial proliferation at room temperature
Travel-related infections
Person-to-person spread - norovirus

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4
Q

What is the commonest cause of gastro-enteritis?

A

Viruses

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5
Q

What is the commonest bacterial pathogen causing gastro-enteritis?

A

Campylobacter

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6
Q

What is the pathogen which causes the most hospital admissions per year?

A

Salmonella

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7
Q

Which type of food is linked to the most cases of food poisoning per year?

A

Poultry meat

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8
Q

In order, what are the most common pathogen isolates in Scotland?

A

Campylobacter
Salmonella
E.coli O157

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9
Q

What are the best defences against enteric infections?

A

Hygiene
Stomach acidity
Normal gut flora
Immunity

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10
Q

Why are you at more risk of gastro-enteritis if on antacids?

A

Lose protection of the acidity of the stomach

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11
Q

Why might you get diarrhoea if you are on antibiotics for C.diff?

A

Taking antibiotics can kill “good” bacteria, allowing C. difficile to multiply and release toxins that damage the cells lining the intestinal wall, causing diarrhoea, abdominal pain, and fever as well as other symptoms

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12
Q

Which group of patients are particularly susceptible to salmonella infections?

A

Immunosuppressed e.g. HIV

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13
Q

What are the different categories of clinical features of diarrhoeal illness?

A

Non-inflammatory
Inflammatory
Mixed picture

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14
Q

What is an example of a non-inflammatory/secretory diarrhoeal illness?

A

Cholera

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15
Q

What is the character of a non-inflammatory/secretory diarrhoeal illness?

A

Lots of watery diarrhoea

Little abdo pain

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16
Q

What is an example of an inflammatory diarrhoeal illness?

A

Shigella dysentery

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17
Q

What is the character of an inflammatory diarrhoeal illness?

A

Inflammatory toxin damage and mucosal destruction
Pain and fever
More systemic upset
Tender abdomen

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18
Q

What is the mechanism of diarrhoea in cholera (non-inflammatory)?

A

Bacterial toxins activate adenyl cyclase and cAMP is made
Increased cAMP levels result in loss of Cl from cells along with Na and K
Osmotic effects leads to massive loss of water from the gut

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19
Q

What is the treatment for non-inflammatory and inflammatory diarrhoeal illness?

A

Oral rehydration therapy

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20
Q

What factors should be considered when assessing a patient with diarrhoeal illness?

A

Symptoms and duration - >2wks unlikely infective gastro-enteritis
Risk of food poisoning
Assess hydration - postural BP, skin turgor, pulse
Features of inflammation - fever, raised WCC

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21
Q

Postural drop is defined as a reduction in systolic BP by how much?

A

20mmHg

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22
Q

What are the clinical signs in a paediatric patient with diarrhoeal illness?

A 
Sunken eyes and cheeks
Decreased skin turgor
Sunken fontanelles
Few or no tears
Dry tongue or month
Sunken abdomen
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23
Q

In which subtype of diarrhoea can fluid and electrolyte losses be particularly severe?

A

Secretory/non-inflammatory diarrhoea

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24
Q

How much fluid can be lost /day in a patient with secretory diarrhoea?

A

1-7L

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25
How can a patient with diarrhoeal illness have hypokalaemia?
Due to K loss in stool
26
What investigations can you do for a patient with diarrhoeal illness?
Stool culture +/- molecular of Ag testing Blood culture Renal function Blood count: neutrophilia, haemolysis (E.coli O157) Abdominal XR/CT if abdomen distended/tender
27
What might a stool antigen test look for?
H.pylori infection
28
What are some differential diagnoses for diarrhoeal illness?
IBD (blood in stool) Spurious diarrhoea Carcinoma Sepsis outside the gut
29
What is spurious diarrhoea?
Chronic constipation causes the bowel to be blocked by hard-packed faeces, some liquid manages to pass = spurious diarrhoea Common in elderly
30
What are the signs that diarrhoea and fever are being caused by sepsis outside the gut?
Lack of abdomen pain/tenderness (goes against gastroenteritis) No blood/mucus in stools (goes against IBD)
31
What is the common treatment of gastro-enteritis?
Oral rehydration with salt/sugar solution | IV saline
32
How long can campylobacter gastroenteritis be incubated?
Up to 7 days
33
After how many weeks would the stools be negative for campylobacter infection?
Within 6 weeks
34
What is the commonest bacterial cause of gastroenteritis?
Campylobacter infection
35
What are differential diagnoses for abdominal pain caused by gastroenteritis?
Appendicitis | Perforation
36
What post-infectious complications can occur as a result of campylobacter gastroenteritis?
Guillain-Barre syndrome | Reactive arthritis
37
How long does it take to complete all tests for bacterial cultures to find pathogens responsible for diarrhoeal illnesses?
3 days
38
What types of detection are used to find bacterial pathogens?
Molecular detection | Antigen detection
39
What are the two species of campylobacter which cause the most infections?
C.jejuni | C.coli
40
What is the commonest cause of bacterial food poisoning in the UK?
Campylobacter
41
What may contain campylobacter which may cause infection?
Chicken, contaminated milk, puppies
42
What pathogen type of gastroenteritis is more likely to hospitalise a patient?
Salmonella gastroenteritis
43
When is the symptom onset usually for salmonella gastroenteritis?
<48 hrs after exposure
44
How long do diarrhoeal symptoms usually last for salmonella gastroenteritis?
<10 days
45
What percentage of salmonella gastroenteritis have positive blood cultures?
<5%
46
What may prolonged carriage of positive blood cultures in stools be associated with?
Gallstones
47
What is a common complication of salmonella gastroenteritis?
Post-infectious irritable bowel
48
How is the character of IBD differentiated from the character of salmonella gastroenteritis?
IBD: few loose sttols in morning, better rest of day SGE: up during night and all day
49
What are the two species of salmonella in the genus?
S.enterica | S.bongori
50
What are the commonest salmonella isolates in the UK?
S.enteritidis | S.typhimurium
51
How does E.coli infection spread?
Contaminated meat | Person-to-person
52
How is E.coli O157 typically characterised?
Frequent bloody stools
53
What toxin does E.coli O157 produce?
Shiga toxin
54
How does the toxin spread?
E.coli O157 stays in gut, toxin gets into the blood
55
What syndrome can the shiga toxin cause?
Hemolytic-uraemic (HUS) syndrome
56
What does hemolytic-uraemic (HUS) syndrome cause?
Haemolytic anaemia Renal failure Thrombocytopenia
57
What is the treatment for hemolytic-uraemic (HUS) syndrome?
Mainly supportive Dialysis No antibiotics Plasmapharesis/IVIG
58
What are the symptoms of hemolytic-uraemic (HUS) syndrome?
``` Abdominal pain Bloody diarrhoea Fever Seizures Lethargy ```
59
How does Shiga toxin cause HUS?
Shiga toxin can enter your bloodstream and cause damage to your blood vessels
60
What are other bacteria which can cause diarrhoeal illness?
Shigella | E.coli - other forms
61
What are the 4 species of Shigella?
S.sonnei S.flexneri S.boydii S.dysenteriae
62
What are other bacterias that cause food poisoning outbreaks?
``` Staph aureus Bacillus cereus (re-fried rice) Clostridium perfringens (undercooked meat left out) ```
63
When are antibiotics indicated for patients with gastroenteritis?
Immunocompromised Severe sepsis or invasive infection Chronic illness (malignancy)
64
With what history should you suspect a patient has C.diff diarrhoea?
History of previous antibiotic treatment
65
What are the treatments for C.diff diarrhoea?
``` Metronidazole Oral vancomycin Fidaxomicin Stool transplants Surgery ```
66
Why is oral vancomycin usually ineffective and why is it effective in C.diff diarrhoea?
Oral vancomycin usually ineffective as doesn't pass through semi-permeable membranes In C.diff diarrhoeal illness oral vancomycin is good as it stays in the gut
67
What 4 C's (anitbiotics) should be avoided to avoid C.diff infection?
Cephalosporins Co-amoxiclav Clindamycin Ciprofloxacin
68
How can C.diff infections be prevented?
Avoid 4C's Reduction in broad spectrum antibiotic prescribing Antimicrobial management team (AMT) and local antibiotic policy Isolate symptomatic patients Hand hygiene Cleaning environment
69
How are C.diff infections managed?
Stop precipitating antibiotic Treatment algorithm - oral metronidazole Oral vancomycin if 2+ severity markers
70
How are parasitic infections usually diagnosed?
Microscopy
71
How should a stool request be sent for a suspected parasitic infection?
Parasites, cysts and ova | P,C&O
72
What parasite causes giariasis?
Giardia duodenalis
73
What are the symptoms of a giardia duodenalis infection/giardiasis?
Diarrhoea Gas Malabsorption Failure to thrive
74
How is giardia duodenalis transmitted?
Direct contact with cattle/dogs/cats/other people | Food/water contaminated with faeces
75
How is giardia duodenalis detected?
Cysts seen on stool microscopy String test Trophozoites seen on duodenal biopsy
76
How is giardiasis treated?
Metronidazole
77
What are the symptoms of a Cryptosporidium parvum infection?
Diarrhoea Nausea and vomiting Abdominal pain
78
How is Cryptosporidium parvum carried?
>150 species of animals
79
How is Cryptosporidium parvum infection spread?
Infected animals/faeces | Contaminated water/food
80
How is Cryptosporidium parvum diagnosed?
Oocysts seen on microscopy
81
What does Entamoeba histolytica cause?
Amoebic dysentery Invasive extraintestinal amoebiasis Usually no bowel symptoms
82
How is an Entamoaeba histolytica infection diagnosed?
Microscopy: trophozoites or cysts | Antibody detection in serum
83
How is an Entamoaeba histolytica infection treated?
Metronidazole | Luminal agent to clear colonisation
84
What is a long term complication of Entamoaeba histolytica infection?
Amoebic liver abscesses
85
What are viral diarrhoea causes?
Rotavirus Norovirus Adenovirus
86
What is the diagnostic test for rotavirus?
Antigen detection in stool
87
What age are patients who usually get rotavirus?
<5yrs
88
When do babies get the rotavirus vaccine?
2 doses: 8 weeks 12 weeks
89
What virus is a common cause outbreaks?
Norovirus
90
Where are norovirus outbreaks most likely to occur?
Hospitals Community: schools, care homes Cruise ships
91
How is norovirus diagnosed?
PCR

Infection (13 decks)

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