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3. Diarrhoea and Dysentary Goldsmid Flashcards

1
Q

What are some common pathogens causing infectious tropical diarrhoea

A 
Rotavirus			(15-25%)
Escherichia coli
	-enterotoxigenic		(10-20%)
	-enteropathogenic	(1-5%)
shigella spp			(5-15%)
Campylobacter jejuni 		(10-15%)
Vibrio cholera 			(5-10%)
Salmonella spp (not S.typhi)	(1-5%)
Cryptosporidium			(5-15%)
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2
Q

What type of diarrhoea do viruses cause?

A

WATERY

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3
Q

Which VIRUSES are associated with

Acute Sporadic/Endemic Diarrhoea of children & adults?

A
  • Rotavirus (60% of children)
  • Calcivirus (20% of children)
  • Astrovirus
  • Adenovirus
  • Torovirus
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4
Q

Which VIRUS is associated with epidemic diarrhoea

A
  • Calcivirus (90% cases)
  • Astrovirus
  • Rotavirus
  • Adenovirus
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5
Q

Which VIRUSES cause diarrhoea in the immunocompromised in the TROPICS

A
  • Cytomegalovirus
  • EBV
  • Adenovirus
  • Astrovirus
  • Picornavirus
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6
Q

How is viral diarrhoea diagnosed?

A

The definitive diagnosis is based upone electron microscopy or antigen detection

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7
Q

What pathological diarrhoeas do bacteria commonly cause?

A 
Cholera
Bacillary Dysentary
E Coli Diarrhoea
Campylobacteriosis
Salmonellosis
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8
Q
  1. What Bacteria cause CHOLERA

What kind of diarrhoea will you see?

A

Vibrio Cholera 01 (classic cholera and El Tor Cholera)
Vibrio cholera 0139 (non invasive or Bengal Cholera)

SEVERE VOMITING + RICE WATER DIARRHOEA

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9
Q
  1. How would you
    - Diagnose
    - Treat
    - Prevent
    Bacterial cholera
A

Diagnosing cholera: Isolation on TCBS medium- yellow colonies
Treatment: Essentially supportive with rehydration
Prevention: Vaccine for travellers (Killed, or live attenuated)

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10
Q
  1. What bacteria causes bacillary dysentary?
A

*dysentary is infection of the intestines resulting in severe diarrhoea with blood and mucous

Caused by Shigella spp
• S.dysenteriae (most serious)
• S.flexnori, S.sonnei, S.boygii
Can cause diarrhoea or dysentery, depending on the cause.

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11
Q
  1. How would you:
    - Diagnose
    - Treat
    Bacillary Dysentary
A

Diagnosis
• Lab confirmation using enrichment broths, selective (macconkey agar), indicator media and sugar tests
Treatment
• If patient has mild, uncomplicated diarrhoea, rehydration may be sufficient.
• If diarrhoea is severe or bloody, then depending on sensitivities:
o Ampicillin; Co-trimoxazole; Ciprofloxacin; Ceftriaxone, Norfloxacin

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12
Q
  1. Many strains of escherichae coli cause diarrhoea.

Which strains cause WATERY DIARRHOEA?

A

ETEC
EAggEC
EPEC

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13
Q

2.. Many strains of escherichae coli cause diarrhoea.

Which strains cause BLOODY DIARRHOEA?

A

EIEC

EHEC

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14
Q
  1. Who are likely to get diarrhoea from ETEC?
A

o Tropical childhood diarrhoea

o Travellers diarrhoea (80+%)

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15
Q
  1. Who are likely to get diarrhoea from EAggEC
A

Enteroaggregative Esh. Coli – EaggEC*
o Persistent diarrhoea
o Travellers diarrhoea

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16
Q
  1. Who are likely to get diarrhoea from EPEC
A

• Enteropathogenic e coli - EPEC*

o Nursery diarrhoea

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17
Q
  1. Who are likely to get diarrhoea from EIEC
A 
o	Dysentery (severe diarrhoea with blood + mucous)
o	Invasive
18
Q
  1. Who are likely to get diarrhoea from EHEC
A

o Haemorrhagic colitis (damage and bleeding)

o Haemolytic uraemic syndrome

19
Q
  1. How do you
    -Diagnose
    - Treat
    E coli related diarrhoea/dysentary
A

Diagnosis: EHEC (especially E.coli 0157; 0111) are sometimes identified by serotyping agglutination tests

Treatment of E.coli diarrhea/dysentery
• Most uncomplicated diarrhoea caused by these e.coli pathotypes does not require antibiotic therapy but may require rehydration
• However, if the diarrheoa is severe, bloody or prolonged, consider: Norfloxacin, Ciprofloxacin, Ampicillin, Co-trimoxazole- depending on sensitivities
• Antibiotic therapy is NOT recommended for EHEC- its seems to enhance toxin production
• If chemoprophylaxis for Traveller’s Diarrhoea is necessary: norfloxacin, rifaximin

20
Q

What are some of the traits of Campylobacteriosis

A

Zoonotic infection due to Campylobacter spp especially Campylobacter jejuni
• Usually watery, but may be bloody
Diagnosis
• special media & atmosphere
Treatment
• Erythromycin, norfloxacin, ciprofloxacin, azithromycin

21
Q
  1. What do typhoid and paratyphoid salmonellas cause? explain pathological progression

How do we diagnose
How do we treat

A

Typhoid and paratyphoid are septicemic illnesses and are not usually associated with diarrhoea
Typhoid may present early with fever and sometimes constipation, but a profuse diarrhoea may develop later in the disease (week 2)
Progression
- Week 1: Stepwise fever, temp-pulse dissociation, headache, myalgias, malaise
- Week 2: Abdominal pain and rose spots on trunk,
- Week 3: Hepatosplenomegaly with intestinal bleeding

Diagnosis in the first instance by blood culture – also fecal and urine culture
TREATMENTwith abx- azithromycin, ciprofloxacin, chloramphenicol etc

22
Q
  1. What do non typhoid salmonellas cause?

How do we diagnose?
How do we treat?

A

These are all zoonotic (can get person-person transfer, but mainly from animals)
Presents as a watery diarrhea or a bloody diarrhea
Is not usually septicaemic

DIAGNOSIS: in the first instance by faecal isolation not blood culture
Should not usually be treated with antibiotics

23
Q
  1. What are some significant protozoan caused infection in the tropics
A
  • Amoebiasis
  • Balantidiasis
  • Giardiasis
  • Cryptosporidiosis
  • Isosporiasis
24
Q
  1. Amoebiasis
    - What protozoan causes it?
    - What are the two types of amoebiasis infeciton?
A

Entamoeba histolytica
Complex infeciton

Types: Luminal or invasive amoebiasis

25
2a. Amoebiasis: | Luminal amoebiasis
• Confined to the large bowel- these people are spreading the infection
26
2b. Invasive Amoebiasis
1. Intestinal - Non dysenteric amoebiasis- abdo pain only - Amoebic dysentery – frank, unformed faeces + blood - Amoebic appendicitis – infection localized to appendix, can rupture - Amoeboma – tumour like mass in the colon 2. Extra intestinal - Liver abscess- amoebic trophozoites can migrate to the liver via mesenteric veins, where a liver abscess may develop - Can spread to lungs, brain, skin - In some cases, the amoebic trophozoites invade the colonic wall causing ulceration and if this erodes they become septicemic - Ulceration can lead to diarrhea, or if extensive, to amoebic dysentery & in some cases to perforation
27
3. How do we diagnose Amoebiasis?
Diagnosis Intestinal type → microscopy/antigen detection in stool sample Extraintestinal → liver abscess drainage (aspiration) & antibody serology Treatment ``` TREATMENT of Amoebiasis o Metronidazole* o Tinidazole o Diloxanide + tetracycline - luminal o Chloroquinine o Paromomycin ```
28
4. Balantidiasis is a protozoan caused infection- what protozoa causes it and what happens?
• Balantidium coli, a pig parasite with a world-wide distribution can also cause dysentery in humans due to large bowel ulceration
29
5. Giardiasis - What protozoan causes it? - What is it? - Diagnosis - What is the treatment -
:: Giardia duodenalis - Widespread zoonotic infection in the tropics - The trophozoites are non-invasive & adhere to the small intestinal villi - They coat the surface so body cant absorb moisture or fat from the bowel - Results in a chronic, steatorrhoeaic, smelly diarrhea DIAGNOSIS Finding trophoz oites or cysts in repeat stool specimens Can be aided by the ‘string test’ or by antigen detection TREATMENT o Metronidazole* o Tinidazole
30
6. Which protozoan cause watery diarrhoea?
* Cryptosporidium spp * Microsporidia * Cyclospora cayetanensis * Isospora belli
31
7. Criptosporidiosis
* Cryptosporidium spp * Sit in the SI * Widespread world-wide zoonotic infection * Most serious in children & immunocompromised (ie HIV)
32
Microsporidia/Cyclosporidium, Isospora Diagnosis Treatment
Microsporidia: Can cause severe watery diarrhea in immunocompromised (‘slim disease’): Azithromycin Cyclosporidium: watery diarrhoea: Trimethoprim-sulfamethoxazole Isospora: Another cause of watery diarrhea in children & the immunocompromised: Trimethoprim-sulfamethoxazole All diagnosed by finding oocytes cysts in the diarrhoea
33
1.Intestinal Helminths
• Intestinal helminth infections are rarely a cause of diarrhea, however some can be associated with dairrhoea, sometimes bloody:
34
2. Intestinal helminths: Intestinal schistosomiasis
(Schistosoma mansoni, S. japonicum, S. mekongi) During the early egg laying stage in a person with a very heavy load of S. mansoni worms, the eggs passing through the large bowel wall can cause ulceration – if this is significant it can manifest as a bloody diarrhea
35
3 Intestinal helminths: Trichuriasis
(Trichuris trichiura) • A heavy load of the whipworm, Trichuris trichiura can cause damage to the wall of the large bowel, resulting in a bloody diarrhea
36
Other infections caused by intestinal helminths (see notes for details)
Strongyloidiasis Eosinophilic enteritis Trichinosis Capillaria philppinensis
37
USING A SYSTEMIC APPROACH TO DIARRHOEA, clinically in a patient with: Few, volumous stools May be watery & severe in cholera May be pale, fatty & smelly in giardiasis Possible pathogens:
(Diarrhoea of small bowel origin) ``` Vibrio cholera ETEC Early shigellosis Giardia V. parahaemolyticus ```
38
USING A SYSTEMIC APPROACH TO DIARRHOEA, clinically in a patient with Many small volume stools
(Diarrhoea of large bowel origin) ``` Shigella Salmonella Campylobacter Diarrheagenic E coli Yersinia enterocolitica Entamoeba histolytica ```
39
USING A SYSTEMIC APPROACH TO DIARRHOEA, clinically a patient with tenesmus, faecal urgency, dysentery
(Colitis) ``` Shigella Salmonella Campylobacter Enteroenvasive E. coli, EHEC Entamoeba histolytica V. parahaemolyticus (rarely) ```
40
USING A SYSTEMIC APPROACH TO DIARRHOEA, clinically a patient with predominant vomiting
(Gastroenteritis) Viral – rotavirus, calcivirus, norovirus Intoxication – Staph aureus food poisoning
41
USING A SYSTEMIC APPROACH TO DIARRHOEA, clinically a patient with predominance of fever
``` (Mucosal invasion) Shigella Salmonella (esp enteric fever group) EIEC Campylobacter Viral agents ```
42
USING A SYSTEMIC APPROACH TO DIARRHOEA, clinically a patient with prolonged diarrhoea (>2 weeks) (suggests protozoa)
(small/large bowel) Giardia Entamoeba histolytica Cryptosporidium

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