13. Gastrointestinal Infections Flashcards
what are some common gastrointestinal infections
- infectious diarrhea
- C. diff
- intra-abdominal infections such as cholangitis, cholecysitits, peritonitis, abscess
the normal stomach contains very few bacteria due to gastric _______ and gastric ______. if either of these are altered, infections may occur
acidity, and motility
which part of the intestines, duodenum, jejunum or ilium has the most bacteria present
ilium is the transitional area between the stomach and colon therefore has more bacteria present (aerobic gram-neg, e.coli, enterococcus)
- duodenum and jejunum have very few bacteria
trauma to which area of the GI tract causes infection more often:
a. stomach
b. colon
c. duodenum
d. jejunum
colon
this is caused by ingestion of water or food products contaminated by pathogenic organisms &/or their individual toxins; is characterized by three or more loose stools or any loose stools with blood in it. involves a disrupted balance between bacterial virulence factors, host factors and ores disposing factors to infection
infectious diarrhea
these are bacteria causing GI disease and have virulence factors that can make infection worse. some can cause a significant host-inflammatory response producing diarrhea
enteropathogens
these cause fluid movement into the gut lumen, leading to fever and diarrhea
enterotoxins
these cause direct mucosal damage, leading to fever and bloody diarrhea. invasive properties of shigella and e.coli allow these bacteria to invade and destroy epithelial cells causing bloody and mucoid stools
cytotoxins
what are some predisposing factors that can contribute to infectious diarrhea
- poor sanitation/hygiene
- immunocompromised
- medications (e.g. PPIs, antibiotics, chemo)
what are some ways to prevent getting infectious diarrhea
- good hygiene
- proper food handling, cooking, storage
what is one of the most important ways to treat infectious diarrhea
rehydration!!!!!
when are stool cultures recommended for infectious diarrhea
- severe acute diarrhea or with high temperature (> 38.5º)
- dysentry (bloody mucoid stools with cramping)
- substantial watery diarrhea
- dehydration
- elderly or immunocompromised
- nursing home patients
- food handlers
- daycare workers
what are some medications used for infectious diarrhea
- antimotility agents (loperamide)
- bismuth subsalicylate
- probiotics (may be questionable)
- antimicrobials (only in specific situations including severely ill, immunocompromised, and patients with conditions that compromise the GI tract)
this causes infectious diarrhea. they are gram negative organisms that live in environmental waters throughout the world. presents with watery, colourless stools with “white flecks” of mucus (“rice water stool”).
cholera (vibrio cholera)
how long after the ingestion of contaminated food does infectious diarrhea with cholera usually occur
12 hours - 5 days
what is the treatment for infectious diarrhea with cholera for adults
high one dose: doxy or azithromycin PO x 1 day
three day dose: cipro, tetracycline or erythromycin PO x 3 days
what is the treatment for infectious diarrhea with cholera for children
azithromycin PO x 1 dose
erythromycin PO x 3 days
cipro PO x 3 days (don’t use cipro in small children)
this is a group of gram negative bacilli found in nature but colonizes hosts including mammals, reptiles and birds. twi main groups: typhoidal and non-typhoidal but typhoidal is not usually seen. illness by this group is caused by consuming contaminated foods including poultry and dairy products
salmonella
how long after ingestion of contaminated food does symptoms of infectious diarrhea with salmonella occur
6 to 72 hours
symptoms include fever, diarrhea (if severe: bloody diarrhea and dehydration)
are antibiotics recommended in non-typhoidal salmonella infectious diarrhea
no! they do not reduce the duration and severity of the illness and may be problematic (adverse effects, prolonging asymptomatic carriage of salmonella, resistance)
true or false: anti motility agents can be used for non-typhoid salmonella infectious diarrhea
if being used they should be used with caution
what should be recommended for someone with non-typhoid salmonella infectious diarrhea
- most need fluid replacement
- specific diets (BRAT)
when are antibiotics indicated for non-typhoid salmonella infectious diarrhea
- cancer
- diabetes
- RA disorders
- HIV infection
- people on immunosuppressive therapies
- very young age
- low gastric pH
- severe infection
what antibiotics are used in non-typhoid salmonella infectious diarrhea
oral FQ PO for 7 days
azithromycin PO for 7 days
cerftiaxone IM/IV 7-10 days (if immunocompromised 14 days)
what is the recommended duration of treatment for patients with HIV and gastroenteritis without bacteremia and have elevated CD4 levels (>200)
7 to 14 days
what is the recommended duration of treatment for patients with HIV and gastroenteritis without bacteremia and have decreased CD4 levels (<200)
2 to 6 weeks
for patients who develop ________________ the treatment is IV and more aggressive
extraintestinal infection
this is a group of gram negative intracellular bacteria consisting of 4 species. is spread through the fecal oral route and can be spread through sexual contact; is the most common cause of dysentry
shigella