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Infectious Diarrhoea Flashcards

(46 cards)

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1
Q

Infective gastroenteritis

A

Inflammation of the stomach and intestines, resulting from bacterial toxins or viral infection.
3+ stools in 24 hours plus at least one of:
- Fever
- Vomiting
- Abdominal pain
- Blood/mucus

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2
Q

Diarrhoea

A
  • Subjective

- Change in fluidity/frequency of stool from normal

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3
Q

Dysentery

A

Type of gastroenteritis caused by microorganisms: large bowel inflammation, abdominal pain and bloody stools

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4
Q

Host’s natural defences

A
  • Gastric acid
  • Gut motility
  • Normal gut flora
  • Gut immunity
  • Age
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5
Q

Mechanism of diarrhoea

A
  • Toxin
  • Invasion
  • Others
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6
Q

Non-inflammatory infective gastroenteritis

A

Secretory enterotoxin- mediated

- Does not invade intestinal mucosa

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7
Q

Non-inflammatory infective gastroenteritis: organisms

A
  • Enterotoxigenic E. coli (traveller’s diarrhoea)
  • Bacillus cereus
  • Staph aureus
  • Vibrio cholera
  • Rotavirus
  • Noravirus
  • Giardia
  • Cryptosporidium
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8
Q

Inflammatory infective gastroenteritis

A

Toxin-mediated damage and mucosal destruction

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9
Q

Inflammatory infective gastroenteritis: organisms

A
  • E. coli
  • Campylobacter
  • Salmonella
  • Staph aureus
  • Shigella
  • Entamoeba histolytica
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10
Q

Infective gastroenteritis epidemiology

A
  • Contaminated foodstuffs
  • Poor storage of produce
  • Travel-related
  • Person-to-person spread
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11
Q

Bacteria causes of infective gastroenteritis

A
  • Campylobacter (most common)
  • Salmonella
  • E. coli O157
  • Cholera
  • Shigella
  • Clostridiodes (Clostridium) difficile
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12
Q

Food poisoning outbreaks

A
  • Staph aureus (toxin)
  • Bacillus cereus (re-fried rice)
  • Clostridium perfringens (undercooked meat)
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13
Q

Most common cause of infective gastroenteritis

A

Viral

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14
Q

Viral causes of infective gastroenteritis

A
  • Rotavirus (most common)
  • Norovirus
  • Adenovirus
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15
Q

Parasitic causes of infective gastroenteritis

A
  • Giardia
  • Cryptosporidium parvum
  • Entamoeba histolytica
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16
Q

Bristol Stool Chart

A

Improving/worsening

  • Frequency
  • Fluidity
  • Timeframe
  • Infective gastroenteritis: Type 6/7
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17
Q

Non-inflammatory infective gastroenteritis: symptoms

A
  • Frequent watery stools

- Little abdominal pain

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18
Q

Inflammatory infective gastroenteritis: symptoms

A
  • SIRS: pain, fever

- Bloody stools

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19
Q

Infective gastroenteritis: history

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A
  • Symptom duration

- Food poisoning risk: dietary, contact, travel

20
Q

Infective gastroenteritis: differential diagnosis

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A
  • IBD (>2 weeks)
  • Spurious diarrhoea
  • Carcinoma
  • Extra-intestinal sepsis
21
Q

Hydration assessment

Study These Flashcards
A
  • Postural BP
  • Skin turgor
  • Pulse
  • Urine flow
  • Muscle cramps
22
Q

Inflammatory features of infective gastroenteritis

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A
  • Fever

- Bloods: raised WCC, culture

23
Q

Infective gastroenteritis: investigations

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A
  • Stool culture
  • Blood culture: immune deficiency
  • Renal function
  • Blood count: neutrophilia, haemolysis
  • AXR/CT
24
Q

Routine stool culture organisms

Study These Flashcards
A
  • Campylobacter
  • Salmonella
  • Shigella
  • E. coli O157
25
Additional bacterial stool culture
- Specific bacteria not routine | - Toxin detection
26
Infective gastroenteritis: viral diagnosis
PCR
27
Infective gastroenteritis: parasite diagnosis
Stool microscopy (PCO) - Parasites - Cysts - Ova
28
Infective gastroenteritis: Prevention
- Hygiene | important for viral
29
Non-inflammatory Infective gastroenteritis: Management
- Rehydration IV (saline), oral (salt/glucose) Antibody therapy not beneficial
30
Inflammatory Infective gastroenteritis: Management
- Rehydration | - Antimicrobials may be appropriate
31
Antimicrobial indications
- Immunocompromised - Severe sepsis - Invasive infection - Chronic illness
32
Complication of E. Coli O157
Haemolytic uraemic syndrome - Blood disorder - Largely children, adults, compromised 1. Acute renal failure 2. Haemolytic anaemia 3. Thrombocytopenia - 5-9 days after diarrhoea - Symptoms: bloody diarrhoea, fever, vomiting, weakness
33
Campylobacter gastroenteritis
Commonest bacterial gastroenteritis - Gram negative spiral bacteria - C-jejuni (90%), C. coli - Inflammatory - Food poisoning - up to 7 days incubation, severe abdominal pain, diarrhoea (bloody) - Routine stool culture - Post-infective: polyneuritis, reactive arthritis - Infections clears in 3/52
34
Salmonella gastroenteritis
- Gram negative rod - Inflammatory - S. enterica, bongori - Food poisoning, travel - <48 hours after exposure - Diarrhoea <10 days - Routine stool culture (lactose non-fermenters) - Post-infectious IBS common (1/4)
35
E. coli O157 gastroenteritis
- Gram negative rod stays in gut - Shiva-Like toxin in blood - Contaminated meat - Person-to-person spread - Frequent bloody stools - Complication: HUS - Routine stool culture: lactose fermenter - Excretion after 3/52 NO ANTIBIOTICS
36
Vibrio cholera
- Gram negative comma - Non-inflammatory - Increased cAMP/Cl/Na/K secretion - Food/water contamination - Watery diarrhoea - Antimicrobial resistance, vaccine
37
Shigella
- Gram negative rod - 4 species: S. sonnei, flexneri, boydii, dysenteriae - Produces SLT (inflammatory) - Food/water contamination, travel - Bloody diarrhoea - Severe: antibiotics
38
Clostridiodes (Clostridium) difficile
- Gram positive rod - C. diff produces Enterotoxin and Cytotoxin - Inflammatory - Previous antibiotics (4C's), institution - Mild diarrhoea to severe colitis, fever, nausea, vomiting - Not routine, bloods, imaging
39
4C's
- Cephalosporin's - Co-amoxiclav - Clindamycin - Ciprofloxacin
40
C. diff: Management
Stop precipitating antibiotic - Oral metronidazole (if no severity markers) - Oral vancomycin (if 2 or more severity markers) - Fidaxomicin - Stool transplants - Surgery Prevention - Reduce broad spectrum antibiotics - Avoid 4C's - Antimicrobial Management Team - Isolate symptomatic patients - Wash hands (not alcohol) - Cleaning environment
41
Giardia duodenalis
- Non-inflammatory - 2 forms: cysts, trophozoites - Contaminated water (cysts) - Giardiasis: abdominal cramps, bloating, nausea, watery diarrhoea, malabsorption, failure to thrive - Stool microscopy: cyst - Diarrhoea specimen, duodenal biopsy, string test: trophozoites - Metronidazole
42
Cryptosporidium parvum
- Non-inflammatory - 2 forms: oocysts, trophozoites - Water contamination (oocysts) - Cryptosporidiosis: watery diarrhoea, nausea/vomiting, abdominal cramps, low grade fever - Stool microscopy - No specific treatment
43
Entamoeba histolytica
- Inflammatory - Water/food contamination - Bloody diarrhoea - Complications: amoebic liver abscess - Stool microscopy - Serum antibody - 10/7 Metronidazole (symptomatic), Diloxanide furoate (asymptomatic)
44
Rotavirus
Most common virus - Infects mature enterocytes (villous body, tip), cell death and lactose intolerance - Non-inflammatory (watery diarrhoea) - Faecal-oral transmission - Antigen detection in stool - Vaccine at 8+12 weeks
45
Adenovirus
- Diarrhoea, fever, vomiting, abdominal pain, respiratory symptoms - 10 days
46
Norovirus
- Highly contagious (infection dose: 18 particles) - Non-Inflammatory - Institutions: hospital, community, cruise ships - Watery diarrhoea, vomiting - PCR testing - Ward closures, strict infection control

Infection (13 decks)

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