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PDAT6 ID > 19 - Infectious Diarrhea > Flashcards

19 - Infectious Diarrhea Flashcards

1
Q

Mild- Moderate C.Diff Diarrhea

Definition

A

< 6 stools/day
&
absence of SYSTEMIC toxicity

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2
Q

When to use
ANTI-MOTILITY DRUGS

for Diarrhea

A

NON-INFLAMMATORY DIARRHEA
watery stools
self limiting –> 2-5 days
AB’s usually not needed

Loperamide
relieves diarrhia within 24 hours
4mg LD –> 2mg after each loose stool

max 16mg/day

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3
Q

SHIGELLA

Symptoms / Treatment

A
  • *Generally a MILD & self-limiting illness**
  • *7 Days**

Can treat with Fluoroquinolones depending on severity

Sx:
BLOODY DIARRHEA
Fever / Cramps
Children may shed shigella via stool x1 month

Only a FEW organisms –> ILLNESS

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4
Q

FQ’s
Levofloxacin / Ciprofloxacin

FIRST LINE FOR WHAT DIARRHEAL INFECTION?

ADR / Elimination / Pregnancy?

A

Typhoidal Salmonella = S. Typhi
Both for Susceptible and MDR to others
5-7 days

Mild-Severe SHIGELLA
or caused by S. Dysenteriae

CONFUSION

RENAL

Pregnancy catergory - C

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5
Q

Rationale for AB Therapy
Infectious Diarrhea

A

↓Morbidity & ↓Mortality

Prevent development of INVASIVE infection

↓Duration of illness

↓Transmission of pathogens

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6
Q

FQ RESISTANT
SHIGELLA

Treatment

A

CEFTRIAXONE
or
AZITHROMYCIN

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7
Q

Typhoidal Salmonella = S. Typhi
TYPHOID FEVER

Multi-Drug Resistant
but
FULLY FQ Susceptible

A
  • *MDR Resistance to:**
  • *Ampicillin / Bactrim / Chloramphenicol**
    but. …
  • *very low MIC to FQ**
  • *STILL USE FLUOROQUINOLONE**
  • *x 5 days**
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8
Q

Typhoidal Salmonella = S. Typhi
TYPHOID FEVER

  • *Low-Level FQ Resistance**
  • *0.125-0.5 MIC**

Treatment

A

NALIDIXIC ACID
used to PREDICT FQ Resistance

> 7 Day Treatment of:
MAX DOSE FQ
or
Azithromycin
or
Ceftriaxone

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9
Q

Mild-Moderate
SHIGELLA
if Abx are used

TREATMENT

A
  • *FLUOROQUINOLONE**
  • *1-2 doses only**
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10
Q

Non-Typhoidal Salmonella
BACTEREMIA / LOCALIZED INFXN
S. enterica / S. Newport

Symptoms / Treatment

A

CEFTRIAXONE > FQ
due to FQ being MORE resistant
Ampicillin / Amoxicillin / Bactrim
3-7 day treatment –> until patient becomes AFEBRILE

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11
Q

Non-Typhoidal Salmonella

WHEN & WHY would we TREAT?

if NOT YET BACTEREMIC?

A

For:
<12 months or > 50 y/o
Immunosupressed
SEVERE symptoms - FEVER + BLOODY DIARRHEA

PRE-EMPTIVE ABX BEFORE Extra-intestinal infxns occur
Osteomyelitis / Endocarditis / Meningitis

CEFTRIAXONE > FQ
due to FQ being MORE resistant
Ampicillin / Amoxicillin / Bactrim
3-7 day treatment –> until patient becomes AFEBRILE

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12
Q

Risk Factors for
Infectious Diarrhea

A

Child Care Facilities

Foodborne + Waterborne

International Travel

AntiMicrobial Agents

Long-Term Care / Hospitilization

Sexual Practice / Animal Exposure

Immunocomprimised

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13
Q
  • *SEVERE** or caused by S. DYSENTERIAE
  • *SHIGELLA**
  • if Abx are used*

TREATMENT

A
  • *FLUOROQUINOLONE**
  • *3-5 days**
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14
Q

When are AB’s recommended for Diarrhea?

A

Severely Ill Patients

Immunocompromised = Aids / Organ Transplant

Treatment of EXTRA-Intestinal infxns

Specific Pathogens:

  • *Typhoidal Salmanella (S. Typhi)** / Bacteremia Salmonella / C. Diff
  • Sometimes = Shigella / Campylobacter*
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15
Q

Why are there
Fewer C.Diff Recurrences
with
FIDAXOMICIN vs Vancomycin?

A

Fidaxomicin
Preserves COLONIZATION RESISTANCE
which prevents the
introduction / persistance of C. Diff

  • *Rapid BACTERICIDAL activity**
  • vancomycin is bacterioSTATIC*

Sequestered into biofilm & adheres to spores
remains active in GUT longer than Vanco

Prolonged post-ABx effect against C.diff

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16
Q

Typhoidal Salmonella = S. Typhi
TYPHOID FEVER

  • *HIGH-Level FQ Resistance**
  • *> 1**

Treatment

A

NALIDIXIC ACID
used to PREDICT FQ Resistance, High = fully nalidixic resistant

  • *CEFTRIAXONE**
  • *10-14 days**

or

  • *AZITHROMYCIN**
  • *7 Days**
17
Q

SEVERE C.Diff Diarrhea

Definition

A

> 6 stools/day
&
WBC > 15,000
+
ab pain / sepsis / hypotension / azotemia

18
Q

FQ’s
METRONIDAZOLE

FIRST LINE FOR WHAT DIARRHEAL INFECTION?

ADR / Elimination / Pregnancy?

A

NOT first line
for C.DIFF only if limited access to vancomycin or fidaxomicin
only for initial episode of non-severe infxn

  • *Metallic Taste / Nausea
  • AVOID ALCOHOL*** - disulfram rxn

LIVER

Pregnancy catergory - unknown

19
Q

NON-TYPHOIDAL SALMONELLA
GASTROENTERITIS
​S. enterica / S. Newport

Symptoms / Treatment

A
  • NO TREATMENT REQUIRED*
  • *Self-Limiting**
  • *GastroEnteritis = NVD**
  • knowing the SITE of infection –> helps determine ABx role*
20
Q

SHIGA TOXIN
producing E. Coli

Symptoms / Treatment​

A

NO ANTIBIOTICS
will INDUCE toxin production

BLOODY DIARRHEA** - **WITHOUT FEVER
hallmark sign
usually from under-cooked BEEF

  • *Shiga Toxin = virulence factor** developing:
  • *HUS** (hemolytic uremic syndrome)

Renal Insufficiency / Anemia / Thrombocytopenia

21
Q

CampyloBacter Jejuni

Symptoms / Treatment

A
  • *Most cases = NO ABx**
  • *Self- Limiting –> 1 week**
  • *ABx recommended for:**
  • *HIGH FEVER** / BLOODY DIARRHEA
  • *PREGNANCY** / Illness >1 WEEK
  • *MACROLIDE** = DRUG OF CHOICE
  • *Azithromycin** > erythromycin

macrolide resistance is LOWER for Campylobacter

22
Q

FQ’s
Ceftriaxone

FIRST LINE FOR WHAT DIARRHEAL INFECTION?

ADR / Elimination / Pregnancy?

A

BACTEREMIA non-typhoidal SALMONELLA

Typhoidal Salmonella = S. Typhi
low & HIGH level FQ resistance
Ceftriaxone 10-14 days

FQ Resistant SHIGELLA

Well Tolerated - Beta lactam

RENAL / LIVER

Pregnancy catergory - B

23
Q

FQ’s
VANCOMYCIN

FIRST LINE FOR WHAT DIARRHEAL INFECTION?

ADR / Elimination / Pregnancy?

A
  • *C. Diff Diarrhea**
  • *more effective for SEVERE**

Well Tolerated

RENAL

Pregnancy catergory - B

24
Q

Typhoidal Salmonella = S. Typhi
TYPHOID FEVER

Symptoms / Treatment

A
  • *FLUOROQUINOLONE**
  • *5-7 Days**

STEROIDS for SEVERE illness

Symptoms:

  • *Systemic Infection**
  • *Fever / Ab discomfort / intestinal Perforation**

Alternative Treatment:
Ampicillin / Bactrim / Chloramphenicol = 14-21 days

25
Q

Acute vs Chronic Diarrhea
&
likely pathogens

A

Acute = <14 days
Commmunity = Salmonella / Shigella / Campylobacter / Shiga (e.coli)
Hospital = C.Diff

Persistant/Chronic = Illness >14 days
recreational water exposure = giardia

26
Q

FQ’s
Azithromycin

FIRST LINE FOR WHAT DIARRHEAL INFECTION?

ADR / Elimination / Pregnancy?

A

CAMPYLOBACTER JEJUNI

low & HIGH FQ resistant
Typhoidal Salmonella (S. Typhi)

FQ Resistant SHIGELLA

well tolerated

LIVER

Pregnancy catergory - B

27
Q

FQ’s
FIDAXOMICIN

FIRST LINE FOR WHAT DIARRHEAL INFECTION?

ADR / Elimination / Pregnancy?

A

C. Diff Diarrhea

RELAPSING C. DIFF DIARRHEA

Well Tolerated

FECES

Pregnancy catergory - B

28
Q

Clinical Presentation of

INFLAMMATORY DIARRHEA

A

Ill / Febrile = FEVER

BLOODY DIARRHEA

Ab Pain

STOOL WBC
lots of it

NonInflammatory Diarrhea has
watery diarrhea

29
Q

Typhoidal Salmonella = S. Typhi
CHRONIC CARRIER

Symptoms / Treatment

A

Chronic Carrier = GALLBLADDER INFECTION

Asymptomatic Carrier –> Spreads infection

Treatment:
1-3 months of ABx

PDAT6 ID (31 decks)

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