Pseudomembranous Colitis and other Clostridiodes difficile Infections and Cholera

Question 1

Cholera and Clostridiodes difficile – both cause gastrointestinal infections

T/F

Answer 1

T

Question 2

Cholera is caused by ________

Answer 2

vibrio cholerae

Question 3

Clostridoides difficile causes a range of gastrontestinal infections including __________

Answer 3

pseudomembranous colitis

Question 4

What is Cholera?

(acute or chronic?) and (mild or severe?) diarrheal disease of Public health importance

Primarily transmitted within the community

Caused by _____________ contaminated with the bacterium Vibrio cholerae.

Answer 4

Acute ; severe

consuming food and water

Question 5

Cholera

Affects only adults

Answer 5

Affects both Adults and Children.

Question 6

Incubation Period for cholera is ______ to ________ after exposures

Answer 6

12hrs to 5 days

Question 7

Vibrio Cholera

These are Gram-__________ ——- .

———- shaped

(Obligate or facultative?) (aerobes or anaerobes?) which are oxidase ________.

Answer 7

negative; rods

comma

facultative

anaerobes; positive

Question 8

The most important vibrio, __________

Answer 8

Vibrio cholerae

Question 9

Vibrio Cholera

V. cholerae is found in the ______ of an infected individual and ends up in the _________ if _______ is untreated.

Transmission – by drinking contaminated water or Contaminated food

Survives in fresh water and in salt water Primarily a disease of _________..

Answer 9

feces

water supply; sewage

poverty

Question 10

Vibrio Cholerae
There are many serogroups of V. cholerae,

Only two –_____ and _______ – cause outbreaks.

Answer 10

O1 and O139

Question 11

Vibrio Cholerae

V. cholerae ____ - caused all recent outbreaks.
V. cholerae _____ – first identified in Bangladesh in 1992 – has never been identified outside Asia.

_____ difference in the clinical presentation of the two sero-groups.

Answer 11

O1

O139

No

Question 12

Vibrio Cholerae

V. cholerae O1 - caused ________

V. cholerae O139 – first identified in _______ in 1992 – has never been identified outside Asia.

Answer 12

all recent outbreaks.

Bangladesh

Question 13

Epidemiology of Cholera

Cholera can be __demic or ___demic

Answer 13

en

epi

Question 14

Cholera

Endemic: defined as _______________ cases were detected during the ___________ with evidence of ________

Epidemic:

•In cholera endemic countries an outbreak represents a _______________________

•In a non-endemic country an outbreak is defined as the occurrence of ____________________ case of cholera with evidence of ___________ in an area where there is not usually cholera.

Answer 14

confirmed cholera

last 3 years; local transmission

greater than expected number of cases.

at least 1 confirmed ; local transmission

Question 15

Transmission of cholera

Linked to inadequate access to ________ and sanitation services
Drinking contaminated water
Eating contaminated food
Direct Person to person uncommon in the community

About ____% of people infected with cholera do not develop any symptoms and remain carriers

Pathogens persist in faeces for ____ to ____ days and are shed into the environment

Answer 15

clean water

75

1 to 10

Question 16

Factors that Aid Transmission of cholera

•Pathogen factors:
________ of ______ in the environment.

Presence of a ___________

•Reservoir and carrier state:
_____ is the only known reservoir

convalescent carrier may be infectious for __________

chronic carriers can remain infectious for _________, up till _______

Answer 16

Persistence of bacteria

potent exotoxin.

Man; 2-3weeks

a month; 10 years.

Question 17

Factors that Aid Transmission of cholera

•Host factors:
Over crowding
Cholera incidence higher among lower socio economic groups which may be attributable to _________

•Environmental factors:
poor environmental sanitation; this results in contamination of food
and water.

Answer 17

poor hygiene.

Question 18

Pathogenesis Of cholera

Once in the gut,

Organism _______________ of the intestine without __________.

______________ is important in pathogenesis.

__________ (_________) is then secreted and is chromosomally encoded and contains __________________ (_______)

Answer 18

adheres to the epithelium

penetration; Adhesion to the microvilli

Choleragen ; Cholera toxin

two types of subunit (A and B).

Question 19

Pathogenesis of cholera

The B subunit binds to _______ on epithelial cell surfaces allowing ______________

The A subunit catalyses _________ of a regulator complex which in turn activates ________ present in the cell membrane of the epithelium of the gut.

The overproduction of ______ stimulates ______________________ into the lumen.

Results in _______ and death (without treatment) result.

Answer 19

gangliosides; internalization of the A subunit.

ADP-ribosylation ; adenylate cyclase

cyclic AMP

massive secretion of ions and water

dehydration

Question 20

Clinical presentation of cholera

________ stool (_______)

Vomiting,Leading to ________________

Less than ____% of total cholera cases develop into severe cases of dehydration

Without any treatment, deaths may reach as high as 50% during outbreaks

Answer 20

Watery Colorless; rice water

moderate to severe dehydration

10

Question 21

Treatment of cholera

__________ is the major component of treatment.

Antibiotic therapy (including ________) is additionally used.

Answer 21

Fluid replacement

tetracycline

Question 22

Vaccination against cholera is completely effective generally recommended.

T/F

Answer 22

F

Vaccination against cholera is only partially effective and not generally recommended. - commonly used by international travelers.

Question 23

Cholera Vaccine is commonly used by international travelers.

T/F

Answer 23

T

Question 24

Safe oral cholera vaccines should be used in conjunction with ________ and _________ to control cholera outbreaks and for prevention in areas known to be high risk for cholera

Answer 24

improvements in water and sanitation

Question 25

Pseudomembranous colitis ________ of the _____ due to an overgrowth of Clostridioides ________ pseudomembranes Characterized by elevated ________ plaques that ______ to form _____________ on the mucosa. Common cause of diarrhea after ____________ More common in people over _____yrs

Answer 25

Inflammation; colon difficile; yellow- white coalesce; pseudomembranes antibiotic use 65yrs

Question 26

Clostridiodes difficile Gram ________, _______ oval spores, capsule in some most are (motile or non-motile?) . Ubiquitous especially in ___________

Answer 26

positive subterminal Motile ; hospital environment

Question 27

Clostridiodes difficile Serogroups:list them Virulence factors:——- and ______

Answer 27

Toxin A & Toxin B,

Question 28

Clostridiodes difficile Toxin A is _______ toxin, Toxin B is _______toxin and both work together in-vivo.

Answer 28

entero cyto

Question 29

Risk factors of Pseudomembranous colitis I taking _______ Staying in the hospital or a nursing home Increasing age, especially over ____ years Having a weakened immune system Having a colon disease, such as inflammatory bowel disease or _______ Undergoing intestinal ________ Receiving chemotherapy treatment for cancer

Answer 29

antibiotics 65 colorectal cancer surgery

Question 30

Pathogenesis: C. difficile spores -resistant many common disinfeprofessionalsctants •Can be no Disturbance of normal colonic flora with antibiotics, cytotoxic drugs, surgery, instrumentation • Eg_____,______ - devastating effect on the flora of the colon. • Others include ______,________,_______

Answer 30

Lincomycin and clindamycin cephalosporins, ampicillin, tetracycline

Question 31

Pathogenesis Of pseudomembrane colitis: Leads to _________ of C.difficile Intra-abdominal __________ _________ of mucosal lining ______ of fluid _______ of colonic mucosa ____________ and ___________

Answer 31

Overgrowth production of toxins Inflammation Outpouring Necrosis Fibrinous exudate and pseudomembrane Bloody diarrhoea.

Question 32

Clinical presentation of C.difficile infections A spectrum of disease • Antibiotic associated ________ Antibiotic associated _____ ______________________

Answer 32

diarrhoea colitis Pseudomembranous colitis

Question 33

Clinical presentation of C.difficile infections A spectrum of disease • Antibiotic associated diarrhoea _________% Antibiotic associated colitis _______% Pseudomembranous colitis _________%

Answer 33

15 –25 25-50 greater than 95

Question 34

Clinical presentation of C.difficile infections All ages may be affected but primarily a disease of the ________ and ___________ Children appear to be ________ to the disease through carriage is highest in children under ______.

Answer 34

elderly and debilitated. refractory 2yrs

Question 35

Pseudomembranous colitis Most cases are ________ acquired

Answer 35

hospital

Question 36

Pseudomembranous colitis Community-acquired C. difficile Reported in people with no known risk factors, including people with no recent health care contact or use of antibiotics. Often due to _________ of C. difficile that _____________

Answer 36

an aggressive strain produces far more toxins than other strains do.

Question 37

Pseudomembranous colitis Complications _________ ______ failure Perforation Toxic ————- Death

Answer 37

Dehydration Renal megacolon

Question 38

Prevention of C.dificile Avoid ________ antibiotic use Wash your hands with soap and warm water Contact precautions:_____ patients and wear disposable gloves and isolation gowns while in the room until at least _________ after diarrhoea stops Good environmental cleaning All surfaces should be carefully washed and disinfected with a product that contains _________

Answer 38

unnecessary Isolate 48 hours chlorine bleach

Question 39

If you don’t keep raw foods—such as beef, poultry, seafood, and eggs—separate from other foods, microbes from the raw foods can spread to other foods T/F

Answer 39

T

Question 40

Microbes can also spread from raw foods to your hands, kitchen utensils, cutting boards, and kitchen surfaces during food preparation T/F

Answer 40

T

Question 41

If you don’t wash your hands, utensils, cutting boards, and surfaces completely after they have come into contact with raw foods, they can spread microbes to other foods T/F

Answer 41

T

Question 42

Infections with microbes—viruses, bacteria, and parasites—cause most food poisoning T/F

Answer 42

T

Question 43

Harmful chemicals also cause some cases of food poisoning T/F

Answer 43

T

Question 44

Common symptoms of food poisoning include ______ or _______ ______ ______ in your abdomen ______ headache Symptoms range from mild to severe and may last from a few hours to several days.

Answer 44

diarrhea or bloody diarrhea vomiting pain in your abdomen fever

Question 45

Less commonly, some types of food poisoning—such as ________, ________ poisoning —can affect your ________ system and Symptoms may include ________ ________ ________ ________ ________

Answer 45

botulism fish and shellfish poisoning Nervous blurred vision headache paralysis tingling or numbness of your skin weakness

Question 46

Many types of bacteria can cause food poisoning, including certain species of ________ certain types of _______ certain species of __________ _________ ______________ certain species of _____ Listeria _________

Answer 46

Salmonella certain types of Clostridium certain species of Campylobacter Staphylococcus aureus Escherichia coli certain species of Vibrio Listeria monocytogenes

Question 47

Many types of bacteria can cause food poisoning, including certain species of Salmonella – _______ certain types of Clostridium, including the common _________ and the less common _________, which causes an illness called _______ certain species of Campylobacter, including __________ Staphylococcus aureus Escherichia coli certain species of Vibrio Listeria monocytogenes

Answer 47

non-typhi C. perfringens C. botulinum; botulism C. jejuni

Question 48

The pathogenesis of foodborne gastroenteritis can be broken down into 3 main mechanisms, namely: Pathogens that _____________ ______ it is consumed (________ toxin) Pathogens that make a toxin ___________ _____ the food is ingested Pathogens that _________________ and ___________, releasing factors that cause an inflammatory diarrhea.

Answer 48

make a toxin in the food before ; preformed in the gastrointestinal tract, after invade the bowel wall and directly break down the epithelial lining

Question 49

Pathogenesis Of food poisoning Enterotoxins productions: (eg, _________, _________ strains of E. coli) They adhere to ________________ These toxins ____________ and cause _________ and ________ by stimulating adenylate cyclase, resulting in _________ _________ produces a similar toxin

Answer 49

Vibrio cholerae; enterotoxigenic intestinal mucosa without invasion impair intestinal absorption secretion of electrolytes and water watery diarrhea C. difficile

Question 50

Pathogenesis Of food poisoning Exotoxins are produced by some organisms (eg, ________,_______,________) The exotoxin can cause gastroenteritis without ________ These toxins generally cause (acute or chronic?) nausea, vomiting, and diarrhea within ______ of ingestion of contaminated food Symptoms abate within ________

Answer 50

Staphylococcus aureus, Bacillus cereus, Clostridium perfringens) bacterial infection Acute ; 12 hours; 36 hours.

Question 51

Pathogenesis of food poisoning Mucosal invasion occurs with some organisms (eg, _______,________, _______, ________, some E. coli subtypes) that invade the mucosa of the small bowel or colon and cause _________,________, exudation of ______- rich fluid, and secretion of electrolytes and water The invasive process and its results can occur ————————- The resulting diarrhea has evidence of this _____ and ________ with ______ and _____ present on microscopy and sometimes with gross blood.

Answer 51

Shigella, Salmonella, Campylobacter, C. difficile ulceration, bleeding protein whether or not the organism produces an enterotoxin invasion and inflammation WBCs and RBCs

Question 52

Preformed toxins ________ and _______ produce heat-stable enterotoxins in the food before it is consumed Transmission: These pathogens are usually transmitted by a food handler and often found in summer picnic foods S aureus: grows well in __________________ Bacillus cereus: grows in _____ foods, such as _____, but is also found in _____, pork, and vegetables Incubation period: ______. Ingestion of preformed toxins leads to (slow or rapid?) onset of symptoms.

Answer 52

Staphylococcus aureus and Bacillus cereus Dairy, meat, eggs, and salads starchy;rice; beef; 1–6 hours; rapid

Question 53

Preformed toxins These bacteria usually affect the __________, causing nausea, profuse vomiting, and abdominal pain/cramping. The emetic enterotoxin can be found in __________ and the __________. Testing is rarely conducted, however, because illnesses are __________ There is ______ risk of person-to-person spread Symptoms- (Gradual or Sudden?) onset of nausea and vomiting after eating suggests ingestion of a preformed toxin

Answer 53

small intestine; vomitus food; self-limited no Sudden m

Question 54

Preformed toxins Diagnosis is usually made based on _________ and ________ Treatment - No antibiotics needed because it is a _________ _________ _________ care and _________ antiemetics help control vomiting. Prognosis: _________ _________ recovery in _________ is typical

Answer 54

history and food diary preformed enterotoxin Supportive ; parenteral Rapid spontaneous ; 1 day

Question 55

Pathogens that transmit illness by making a toxin after consumption C perfringens Transmission: ingestion of __________ that have germinated in food products, such as beef, pork, home canned foods, and poultry1 Pathophysiology: Once spores reach the __________ , they produce __________, leading to __________ diarrhea. Incubation: __________ Symptoms: frequent __________ and abdominal cramping; rarely, fever, nausea, and vomiting

Answer 55

spores small intestine; enterotoxin; watery diarrhea 6–48 hours; watery stools

Question 56

Pathogens that transmit illness by making a toxin after consumption C perfringens Duration: usually ___________ Treatment: Rarely does a patient need _____________. Antibiotics are of ____ given the ______________________ in the short lived nature of this illness, but fecal _________ are present because this is an __________ gastroenteritis.

Answer 56

less than 24 hours intravenous fluids no use short duration of symptoms leukocytes ;inflammatory .

Question 57

Pathogens that transmit illness by making a toxin after consumption C perfringens Prognosis: _________ , rarely lasting more than _________. Ingestion of _________ strain of these bacteria, however, can lead to a serious illness, _________(_________). Symptoms include severe abdominal pain, vomiting, diarrhea, and possible _________ and can be rapidly fatal. Prevention: Do not _________ that have already been cooked warm for long periods of time.

Answer 57

Self-limited ; 24 hours; type C enteritis necroticans (pigbel) shock; keep foods