2 - Diarrhea

Question 1

Suspect viral AGE if:

Answer 1

Prominent vomiting
14+hr incubation
Lasts only 3 days
No bacterial warning signs
No epidemiological clues

Question 2

Adenovirus

Answer 2

More prolonged than Rota

Causes the “cold” as well

Question 3

Calcivirus

Answer 3

Kids

Intussusception

Question 4

Norovirus

Answer 4

Cruise ships

Question 5

Rotavirus

Answer 5

Common AGE in kids
URTIs
Vaccine avilable

Question 6

CMV

Answer 6

Immunocompromised

Possible dysentery

Question 7

Yersinia?

Answer 7

Severe cramping
Mis-Dx’d as appendicitis
Polyarticular arthritis

Question 8

Staphylococcus aureus

Answer 8

Toxin in food
No organism in body
“I want to die” AGE

Question 9

Bacillus cereus

Answer 9

Fried rice

Question 10

Clostridium perfringens

Answer 10

Gas gangrene

Mild GI

Question 11

Campylobacter jejuni

Answer 11

Chickens cause 1/2 the cases

Pt looks like shit
ABD pain
High fever
HA
Myalgias

10+ watery BLOODY BM’s per day

Txt with Azi

Question 12

Salmonellosis

Answer 12

Eggs, reptiles

12-36hrs post-exposure

N/V
Mild cramping
NON-BLOODY loose or watery diarrhea

Txt - Cipro

Question 13

Typhoid fever

Answer 13

Salmonella typhi (the severe one)

Food-borne

Hallmark - invasion and multiplication - mononuclear phagocytic cells - SYSTEMIC (bacteremia develops)

Incubate 3-60 days (avg 10) - asymptomatic

Week 1 - HA/fever/malaise
Week 2 - rose spots on chest / fade with pressure / dicrotic pulse / toxic appearing / splenomegaly
Week 3 - Weight loss / delirium / pea soup diarrhea / thready pulse - DEATH MAY OCCUR HERE
Week 4 - slowly get better (if you don’t die)

Txt - cipro - if from Asia, ceftriax or Azi

Question 14

Shigellosis

Answer 14

Bacillary dysentery 
Invades epithelium (colonic) AND produces enterotoxin

Acute BLOODY diarrhea
Tenesmus
Mucus poop
Fever
ABD tenderness 

Self-limited usually, or cipro

NO NARCOTIC-RELATED ANTIDIARRHEALS

Question 15

Different ecolis

Answer 15

ETEC - traveler
EPEC - peds
EIEC - shigella-like
EHEC - causes HUS

Question 16

ETEC

Answer 16

ABD cramps
Frequent EXPLOSIVE BM’s
N/V

Txt - Loperamide and Cipro

Question 17

EHEC / O157:H7

Answer 17

Shiga toxin
Starts watery -> switches to bloody
HUS 10% of the time

Txt - NO ABX / NO ANTI-DIARRHEALS / treat the HUS c dialysis if needed

Question 18

Cholera

Answer 18

Vibrio cholerae

Death possible within HOURS of infection 2/2 massive dehydration

Rice-water stools
Painless
Occasional ABD cramps
AFEBRILE

Txt - FLUIDS!!! ABX can shorten course

Question 19

Listeria

Answer 19

Uncommon, generally

Important for: preggos, hispanics, neonates, old farts, AIDS’y

Illegal milk and cheese, cold cuts, ice cream

MC sxs = diarrhea, non-invasive (possible bacteremia)

Neonates? Sepsis or stillbirth, all kinda long-term problems

Txt at-risk people - amp / gent / bactrim