Infectious Diarrhoea

Question 1

What are 4 ways which gastro-enteritis can spread?

Answer 1

Contamination of foodstuffs
Poor storage of produce
Travel-related infections
Person-person spread

Question 2

How is contamination of foodstuffs linked to spread of G-E?

Answer 2

Intensely farmed chicken tends to facilitate campylobacter spread

Question 3

How is poor storage of produce linked to spread of G-E?

Answer 3

Bacterial proliferation at room temperature

Question 4

How does person-to-person spread affect G-E spread?

Answer 4

Norovirus passed on

Question 5

How many people visit the GP every year because of GI infection?

Answer 5

2% of the population

Question 6

What is the most common cause of G-E?

Answer 6

Viral

Question 7

What is the most common bacterial pathogen causing G-E?

Answer 7

Campylobacter

Question 8

Which pathogen causes the most G-E hospital admissions every year?

Answer 8

Salmonella

Question 9

What are some defences against enteric infections?

Answer 9

Hygiene
Stomach acidity
Normal gut flora
Immunity

Question 10

What might compromise stomach acidity?

Answer 10

Antacids

Infection

Question 11

How might normal gut flora be compromised?

Answer 11

Clostridium Difficile Diarrhoea

Question 12

How may immunity be compromised?

Answer 12

HIV

Salmonella

Question 13

Give an example of a non-inflammatory G-E.

Answer 13

Cholera

Question 14

Give an example of an inflammatory G-E.

Answer 14

Shigella dysentery

Question 15

What G-E organism could give a mixed picture?

Answer 15

C. Difficile

Toxins which increase secretion as well as inflammation

Question 16

How does non-inflammatory present?

Answer 16

No fever
Little to no abdominal pain
Frequent watery diarrhoea

Question 17

What is the effect of cholera?

Answer 17

Increases cAMP secretion
Increases Chloride secretion
These both cause massive loss of fluid from the gut

Question 18

Describe enterotoxigenic e-coli?

Answer 18

Common cause of traveller’s diarrhoea
Frequent watery diarrhoea
Secretory toxin

Question 19

How is inflammatory G-E characterised?

Answer 19

Frequent watery stool
Inflammatory toxin damage
Mucosal destruction
Pain
Fever

Question 20

What is the main stay of treatment for diarrhoea?

Answer 20

Rehydration

Question 21

What are some signs of G-E in infants?

Answer 21

Dry mouth
Decreased skin turgor
Few or no tears
Sunken eyes, cheeks, abdomen, fontanelle

Question 22

What are some useful investigations for diarrhoea?

Answer 22

Stool culture
Blood culture
Renal function
Blood Count (Neutrophilia, haemolysis)

Question 23

What is a possible differential diagnosis for diarrhoea?

Answer 23

IBD
Spurious diarrhoea
Carcinoma

Question 24

Can sepsis occur outside the gut with fever and diarrhoea?

Answer 24

Yes

Question 25

Describe the onset of salmonella G-E.

Answer 25

Symptoms usually onset within 48 hours of exposure | Diarrhoea usually lasts <10 days

Question 26

What are some features of e.coli 0157?

Answer 26

Usually from meat or person-to-person spread Produces shiga toxin Can cause haemolytic-uraemic syndrome (HUS)

Question 27

What are some characteristics of HUS?

Answer 27

Renal failure Haemolytic anaemia Thrombocytopaenia

Question 28

Are antibiotics indicated in e.coli 0157?

Answer 28

No

Question 29

What are some causes of occasional food poisoning outbreaks?

Answer 29

``` Staph Aureus Baccilus cereus (re-fried rice) Clostridium Prefringes (Undercooked meat) ```

Question 30

What bacteria is often found in undercooked meat?

Answer 30

Clostridium perfringens

Question 31

When should antibiotics be given in G-E?

Answer 31

Indicated in G-E for immunocompromised, severe sepsis, invasive infection or chronic illness

Question 32

When are antibiotics not indicated in G-E?

Answer 32

Healthy patient with non-invasive infection

Question 33

How is clostridiodes difficile diarrhoea treated?

Answer 33

``` Metronidazole Oral vancomycin Fidaxomicin (expensive) Stool transplant Maybe surgery ```

Question 34

What are the 4 Cs antibiotics?

Answer 34

Cephalosporins Co-Amoxiclav Clindamycin Ciproflaxin

Question 35

How can we prevent spread of clostridiodes?

Answer 35

``` Reduce broad spectrum antibiotics Avoid 4Cs Isolate symptomatic patients Wash hands between patients Cleaning environment ```

Question 36

How is CDI managed?

Answer 36

Stop precipitating antibiotic if possible | Oral vancomycin

Question 37

How does giardia duodenalis present?

Answer 37

Diarrhoea Gas Malabsorption Failure to thrive

Question 38

How does cryptosporidium present?

Answer 38

Diarrhoea Nausea Vomiting Abdominal pain

Question 39

How is cryptosporidium parvum spread?

Answer 39

Infected animals/faeces contaminate water/food

Question 40

How is norovirus diagnosed?

Answer 40

PCR