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AIP: Diarrhoea > Infective diarrhoea > Flashcards

Infective diarrhoea Flashcards

1
Q

What is the most common cause of infectious diarrhoea?

A

viruses (rather than bacteria or parasites)

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2
Q

How long do nearly half of episodes of diarrhoea last for?

A

less than 1 day

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3
Q

What are 4 routes via which transmission of GI infection from person to person may occur?

A
  1. Faecal-oral
  2. Foodborne
  3. Environmental
  4. Airborne
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4
Q

What causes ‘food poisoning’?

A

usually caused by enterotoxins produced by the microorganism rather than the microorganism itself

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5
Q

How long does food poisoning usually last for?

A

last than 24 hours

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6
Q

What are the 3 most common causes of bacterial gastroenteritis from food, and which foods are they found in?

A
  1. Clostridium perfringens - meat
  2. Bacilus cereus - rice, pasta, meat, vegetable dishes, dairy products
  3. Staphylococcus aureus - cooked meats and cream products
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7
Q

What is the most common cause of viral gastroenteritis in children?

A

rotavirus (reduction in prevalence due to vaccine)

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8
Q

How are most viral causes of gastroenteritis transmitted between people?

A

faecal-oral route (more rarely, by contact with contaminated surfaces)

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9
Q

What are 4 possible symptoms of viral gastroenteritis?

A
  1. Diarrhoea
  2. Vomiting
  3. Fever
  4. Abdominal pain
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10
Q

How long does it take viral gastroenteritis to settle?

A

vomiting usually settles within 1-3 days, diarrhoea within 5-7 days

but can persist for 2 weeks

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11
Q

Why is viral gastroenteritis infection uncommon in adults?

A

immunity is long-lasting

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12
Q

What is the commonest cause of gastroenteritis in England and Wales?

A

Norovirus

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13
Q

When is the prevalence of norovirus higher?

A

during colder months

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14
Q

Why can infection of norovirus occur in people of all ages?

A

immunity is not long-lasting

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15
Q

What is the time scale of norovirus?

A

symptoms begin 24-48 hours after infection and last for 12-60 hours

most people make full recovery within 1-2 days

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16
Q

What are the typical symptoms of norovirus?

A
  • sudden onset nausea followed by projectile vomiting and watery diarrhoea
  • fever, headache, abdominal pain, myalgia
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17
Q

What is the typical transmission of norovirus? What are 2 other routes?

A
  • faecal-oral route
  • can also be transmitted by consumption of contaminated food (e.g. oysters) or water
  • contact with contamined surfaes e.g. toilets, soft furnishings, floors
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18
Q

In which environments are norovirus outbreaks common?

A

semi-closed environments e.g. schools, hospitals, care-homes, cruise-ships

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19
Q

What are 3 viruses that can cause gastroenteritis?

A
  1. Rotavirus
  2. Norovirus
  3. Adenovirus
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20
Q

What are 5 bacterial causes of gastroenteritis?

A
  1. Campylobacter jejuni and Campylobacter coli
  2. Escherichia coli
  3. Salmonellosis: Salmonella typhia and Salmonella paratyphi
  4. Shigella dysenteriae, Shigella flexneri, Shigella boydii, Shigella sonnei
  5. Yersinia enterocolitica
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21
Q

What are the most commonly reported bacterial causes of infectious intestinal disease in England and Wales?

A

Campylobacter (jejuni and coli)

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22
Q

What are 6 features of campylobacter infection?

A
  1. Asymptomatic (25-50%)
  2. Diarrhoea (may be bloody)
  3. Nausea
  4. Vomiting
  5. Abdominal cramps
  6. Fever
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23
Q

How long does campylobacter usually last for?

A

most cases self-limiting within 2-3 days, usually resolve within 1 week

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24
Q

What is commonly the cause of campylobacter infection?

A

usually associated with the consumption of contaminated food and drink e.g. undercoorked meat (esp. poultry), unpasteurised milk, untreated water

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25
Q

Which age group is most commonly affected by E. coli gastroenteritis?

A

children aged 1-4 years

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26
Q

How long does E. coli gastroenteritis usually last for?

A

usually resolves within 10 days, self-limiting

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27
Q

What are 4 ways E. coli infection can be transmitted?

A
  1. contaminated food - meat, salad, water, unpasteurised milk
  2. Person-to-person: faecal oral
  3. Infected animals (cattle, sheep, goats)
  4. Environmental exposure to contaminated water
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28
Q

What is the commonest cause of salmonellosis?

A

ingestion of contaminated foods: red and white meats, raw eggs, milk and dairy products

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29
Q

What are 6 typical features of salmonellosis?

A
  1. Watery and sometimes bloody diarrhoea
  2. Abdominal pain
  3. Headache
  4. Nausea
  5. Vomiting
  6. Fever
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30
Q

How long does salmonellosis usually last for?

A

usually lasts for 4-7 days, people usually recover spontaneously

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31
Q

How is shigella most commonly transmitted?

A

person-to-person by faecal oral route

in households, nurseries, and schools

32
Q

In what age group does shigellosis most commonly occur?

A

children less than 5 years of age, but infection can occur in all ages

33
Q

In the UK at what time of year do shigellosis infections peak?

A

late summer

34
Q

What are 7 of the features of shigella?

A
  1. diarrhoea (may have blood and mucus)
  2. fever
  3. abdominal cramps
  4. nausea
  5. vomiting
  6. headache
  7. malaise
35
Q

What is the usual time course of shigella infection?

A

symptoms 1-3 days after infection

resolves in 5-7 days

36
Q

In what age group does Yersinia infection typically occur?

A

children

37
Q

What are 4 possible features of Yersinia infection?

A
  1. Watery diarrhoea (often bloody)
  2. Fever
  3. Abdominal pain
  4. Right-sided abdominal pain (older children/adults)
38
Q

What is the usual time course of Yersinia infection?

A

Symptoms typically develop 4–7 days after exposure and may last 2 days to 6 weeks

39
Q

What is the method of transmission of Yersinia infection?

A

direct contact with infected animals and person-to-person (faecal-oral route), and through contaminated food (especially raw pork and pork products) and water

40
Q

What are 3 types of parasites which can cause gastroenteritis?

A
  1. Cryptosporidium
  2. Entamoeba histolytica (amoebiasis)
  3. Giardia intestinalis or Giardia lamblia
41
Q

What is the most common protozoal cause of gastroenteritis in the UK?

A

cryptosporidiosis

42
Q

What proportion of cases of cryptosporidiosis are associated with foreign travel?

A

20%

43
Q

What proportion of cryptosporidiosis show recurrence of symptoms?

A

1/3

44
Q

How much of amoebiasis is related to foreign travel?

A

most cases

45
Q

What proportion of amoebiasis is asymptomatic?

A

90%

46
Q

What are symptoms of amoebiasis when symptomatic?

A

amoebic dysentery can occur: fever, severe abdo pain, blood and mucus in faeces

47
Q

What foreign travel are many cases of giardiasis associated with?

A

particularly from SE Asia

48
Q

What are 6 features of giardiasis?

A
  1. diarrhoea
  2. malaise
  3. abdominal pain
  4. loss of appetite
  5. flatulence
  6. bloating
49
Q

What is the most commonly identified pathogen in returning travellers with prolonged diarrhoea?

A

giardiasis

50
Q

What are 17 complications of gastroenteritis?

A
  1. Dehydration, electrolyte disturbance, AKI
  2. Haemorrhagic colitis
  3. Haemolytic uraemic syndrome (HUS)
  4. Thrombotic thrombocytopaenic purpura (TTP)
  5. Reaction arthritis including Reiter’s syndrome
  6. Aortitis, osteomyelitis
  7. Sepsis
  8. Toxic megacolon
  9. Pancreatitis, sclerosing cholangitis, liver cirrhosis
  10. Faltering growth
  11. Chronic diarrhoea
  12. IBS
  13. IBD
  14. Acquired or secondary lactose intolerance
  15. Guillain-Barré syndrome
  16. Meningitis
  17. Invasive entamoeba infection
51
Q

What are 5 symptoms that should make yous suspect gastroenteritis?

A
  1. Sudden-onset diarrhoea
  2. Nausea or sudden onset of vomiting
  3. Fever or general malaise
  4. Abdominal pain or cramps
  5. Associated headache, myalgia, bloating, flatulence, weight loss, malabsorption, depending on underlying cause of infection
52
Q

What are 7 important aspects of the management of suspected gastroenteritis?

A
  1. History
  2. Examination - features of shock, sepsis, malnutrition
  3. Stool culture and sensitivity testing if indicated
  4. Stool culture and sensitivity if contact with affected person or outbreak of diarrhoea
  5. Do not routinely arrange blood tests for acute gastroenteritis
53
Q

What are 2 types of drugs in the history that can cause gastroenteritis?

A
  1. PPIs
  2. Antibiotics
54
Q

What are 2 types of drugs that may need to be stopped during acute diarrhoeal illness?

A

ACEi and diuretics

55
Q

What are 3 types of drugs that may be affected by severe diarrhoea and vomiting?

A

COCP, warfarin, anticonvulsants

56
Q

What are 9 situations when you should arrange for stool culture and sensitivity testing in gastroenteritis?

A
  1. Systemically unwell or immunocompromised
  2. Acute painful diarrhoea or blood, mucus and/or pus in stool (suggesting possible dysentery, such as caused by Shiga toxin-producing E. coli)
  3. If recent antibiotic or PPI treatment, or recent hospital admission (C. diff)
  4. Diarrhoea has not resolved by day 7
  5. Suspected food poisoning
  6. If recent travel abroad other than W Europe, N America, Australia, N Zealand
    1. send additional 3 specimens for ova, cysts and parasites 2-3 days apart to exclude parasite infection
  7. All children 5 years old or under who attend
  8. If in person at risk of transmission or infection e.g. food handlers
  9. Uncertainty about diagnosis to help exclude alternative causes
57
Q

What are 5 symptoms of clinical dehydration in children?

A
  1. Appears to be unwell or deteriorating
  2. Altered responsiveness e.g. irritable, lethargic
  3. Decreased urine output
  4. Skin colour unchanged
  5. Warm extremities
58
Q

What are 3 clinical symptoms of shock in children?

A
  1. Decreased level of consciousness
  2. Pale or mottled skin
  3. Cold extremities
59
Q

What are 11 signs of clinical dehydration in children?

A
  1. Altered responsiveness
  2. Skin colour unchanged
  3. Warm extremities
  4. Sunken eyes
  5. Dry mucous membranes (except for mouth breathing)
  6. Tachycardia
  7. Tachypnoea
  8. Normal peripheral pulses
  9. Normal capillary refill time
  10. Reduced skin turgor
  11. Normal BP
60
Q

What are 8 signs of clinical shock in children?

A
  1. Decreased level of consciousness
  2. Pale or mottled skin
  3. Cold extremities
  4. Tachycardia
  5. Tachypnoea
  6. Weak peripheral pulses
  7. Prolonged capillary refill
  8. Hypotension (decompensated shock)
61
Q

What are 3 situations to arrange urgent hospital admission in gastroenteritis?

A
  1. Systemically unwell and/or clinical features suggesting severe dehydration and/or progression to shock
  2. Intractable vomiting or high-output diarrhoea
  3. Suspected serious complication, such as sepsis
62
Q

What are 4 situations to consider arranging hospital assessment in gastroenteritis?

A
  1. Clinical features suggesting potentially life-threatening or serious alternative diagnosis
  2. Inadequate response to oral rehydration salt solution, unable to take it, or clinically deteriorating
  3. Risk factors for developing dehydration e.g. in elderly, immunocompromised, those with co-morbid conditions or concurrent illness
  4. Person/carers are unable to provide appropriate management safely at home
63
Q

What are 8 aspects of the management of gastroenteritis in adults?

A
  1. Provide advice on support and information e.g. patient.info leaflets, NHS leaflets
  2. Advise on how to monitor fluid intake and prevent/treat dehydration - encourage fluid intake, use of oral rehydration salt (ORS) solution as supplemental fluid
  3. Advise drug treatment with anti-diarrhoeal (or antimotility) drugs, antiemetics, and probiotics NOT routinely recommended
  4. Don’t routinely prescribe antibiotics - only following stool culture and sensitivity
  5. Advise on methods to prevent transmission of infection - washing hands, flush toilet, don’t share towels
  6. Advise not to attend work for at least 48 hours after last episode of diarrhoea or vomiting
  7. Advise need for follow up and when to seek urgent medical advice
  8. Notify local health protection team immediately by completing notification if notifiable disease
64
Q

What should you advise adults with signs of dehydration who can be maanged at home?

A

advise to use ORS solution frequently and in small amounts, such as 200-400ml given after every loose motion, dose according to fluid loss

after rehydration gradually reintroduce usual diet - small, light, non-fatty, non-spicy meals

65
Q

When are anti-diarrhoela drugs used in adults?

A

if mild-to-moderate diarrhoea when rapid resolution would enable person to resume essential activities

(can purchase over counter)

66
Q

What are 2 situations when you should not use anti-diarrhoeals?

A
  1. Blood, mucus and/or pus in stools or high fever (possible dysentery)
  2. Shigellosis or confirmed probably or suspected Shiga toxin-producing E. coli (STEC) infection following stool culture and sensitivity
67
Q

What are 5 notifiable gastroenteritis situations to the local health protection team?

A
  1. Food poisoning (e.g. Bacillus cereus, Campylobacter, Clostridium perfringens, Cryptosporidium, Entamoeba histolytica)
  2. Haemolytic uraemic syndrome
  3. Infectious bloody diarrhoea e.g. Shigella
  4. Enteric fever (typhoid or paratyphoid)
  5. Cholera
68
Q

What is the recommended management of confirmed campylobacter?

A

antibiotics not usually needed

if symptoms severe or immunocompromised, clarithromycin 250-500mg twice daily for 5-7 days within 3 days of onset

69
Q

What is the treatment of confirmed amoebiasis / amoebic dysentery?

A

drug treatment such as metronidazole following anti-protozoal drug diloxanide

seek specialist advice regarding need for microbiological clearance to confirm treatment success, 1 week after completing treatment

70
Q

What is the treatment for confirmed E. coli gastroenteritis?

A

no effective abx treatment

2 consecutive negative stool samples usually needed, taken at least 24 hours apart, once person symptom free for at least 48h, before can return to work

71
Q

What is the specific treatment for giadiasis?

A

tinidazole 2g as single dose

72
Q

What is the treatment of confirmed salmonellosis?

A

antibiotic treatment not usually needed

73
Q

What is the treatment for confirmed shigellosis?

A

antibiotic treatment not usually needed if mild symptoms

if severe/immunocompromised, seek specialist advice on need for abx treatment

74
Q

What are the 2 types of anti-diarrhoeal agents?

A
  1. Loperamide
  2. Diphenoxylate
75
Q

What is the drug class of antidiarrhoeal agents?

A

opioid agonists

76
Q

How does endoscopic exploration differ for acute vs chronic diarrhoea?

A

flexible sigmoidoscopy used in the acute setting while colonoscopy can be performed for chronic cases

77
Q

To summarise, what is the treatment (if indicated) for:

  1. campylobacter
  2. E. coli
  3. salmonellosis
  4. amoebiasis
  5. giardiasis
  6. shigellosis?
A
  1. Campylobacter: none usually needed, clarithromycin 250-500mg for 5-7 days
  2. E. coli: no antibiotic treatment available
  3. Salmonellosis: none needed
  4. Amoebiasis: diloxenide then metronidazole
  5. Giadiasis: tinidazole 2g single dose
  6. Shigellosis: none needed

AIP: Diarrhoea (8 decks)

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