42. Acute enterocolitis. Rehydration therapy. Flashcards
What are the causes for enterocolitis ?
Bacteria- Salmonella,
shigella,
Ecoli
Vibrio cholera
, campylobacter (fecal oral, foodborne, contaminated water)
staphylococcus heat stable enterotoxin - food poisoning
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Most common -
fecal-oral
Mucosal damage and bilious atrophy - cannot absorb
Virus- enterovirus
Rotavirus - LEADING CAUSE OF SEVERE DIARRHEA
Norwalk virus (norovirus / very very common)
Adenovirus
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Fungi - candiasis- especially immunocompromised
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Parasites - giardia lamblia ( not always with clinical manifestations but high frequency of infestation)
Balantidium coli
Blastocystis
Cryptosporidium ( Diarrhea in immunosuppression)
Entamoeba histolytica- produces amebian dysentery common in tropical areas)
How is is salmonella transmitted
Foodborne- poultry , raw eggs, milk
Incubation period - 0-3 days
Clinical features of salmonellosis
Fever - resolving within 2 days
Chills
Headache
Myalgia
Cramping Abdominal pain
Severe vomiting
Inflammatory diarrhea
Damage to the mucosal lining or brush border which leads to passive loss of protein rich fluids due to decrease ability to absorb them)-
watery
bloody (bloody not bad as shigella) ( dysentery- when blood in them)
DEHYDRATED Delayed capillary refill Sunken eyes Dry mucous membranes Tachycardia
Inquire about travel
Contact people
What is enteric fever?
Caused by s tyhi and others Present with high fever Anorexia Abdominal pain. Myalgia Diarrhoea Constipation Delirium Rose spots - on anterior thorax - should fade
Diagnosis of shigelosis/ salmonelosis?
Fecal occult blood test -mucoid stools ( shigella has more blood)
Fecal leukocytosis fecal leukocytes
CBC
-if enteric fever - anemia and thrombocytopenia
Leukocytosis
Anemia
Shigella- leukocytosis is rare
Serology - salmonella agglutinins- not recommended!
Stool culture or blood culture or urine
Stool- NAAT- amplifier of DNA or RNA in stool
Sigmoidoscopy- distinguish between shigella and and idiopathic UC
Enzyme immunoassay - shiga toxin
Treatment salmonella?
If uncomplicated- if caused by non typhi- antibiotics not indicated because it is not effective
IV HYDRATION
individuals at high risk for invasive disease include ampicillin, amoxicillin, and trimethoprim-sulfamethoxazole (TMP-SMZ). In areas with multidrug resistance, cefotaxime or ceftriaxone are recommended.
Treatment of invasive Salmonella disease (bacteremia, extraintestinal manifestations)
Empiric antimicrobial therapy should include a broad-spectrum cephalosporin (cefotaxime or ceftriaxone). Once susceptibilities are available, narrower-spectrum therapy includes ampicillin, amoxicillin, as well as broader-spectrum agents such as chloramphenicol, TMP-SMZ, or a fluoroquinolone.
Enteric fever
Ceftriaxone / chloramphenicol /ampicillin TMP-SMZ
How is shigella transmitted?
Fecal oral
Food- unpasteurized milk products and raw
Produce the enterotoxin - shiga and endotoxins
What are the shigellosis symptoms
3 days to one week Acute mucoid Bloody diarrhea (inflammatory and dysentery) Abdominal cramping Tenesmus Fever Occasional vomiting Dehydration
Treatment of shigellosis?
ciprofloxacin, azithromycin, and ceftriaxone
Because resistant to ampicillin and TMP- SMX
Clinical manifestations of campylobacter?
Inflammatory dysentery diarrhea- mostly ( dehydration can occur) subsiding in one or two week
Periumbilical cramping
Intense abdominal pain!- Which mimics appendicitis
Myalgia
Vomiting
Headache
High fever
Tender abdomen
C jejune rarely causes bacteremia
Diagnosis of campylobacter
Stool Culture- requires special media - campy- BAP media
Presumptive diagnosis with fecal specimen in dark in dark feels microscopy demonstrating daring motility and vibrio forms
Sigmoidoscopy
Treatment for campylobacter
Intravenous hydration or oral rehydration which is the mainstay of the treatment
In severe cases we give macrolides such as erythromycin and azithromycin
What are the different types of Ecoli and their characteristics
Enterpathogenic ecoli
Resides in natural gutflora of small intestine
Most common in children less than five years old
Adherence to intestinal epithelium → destruction of microvilli
Blocks absorption by flattening the villi
Clinical- watery diarrhea - two weeks
Low grade fever
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Enterotoxigenic Ecoli
Travelers diarrhea - cause of diarrhea IV children in developing countries
In small intestine
Gives two types of two types of enterotoxins:
Heat-labile enterotoxin and heat stable -→ secretory diarrhea
Abdominal cramping
Vomiting
Fever
————
Enterohemorrhagic
Fecal oral or through contaminated food - infants and toddlers at risk
Shigella like toxin released 1/2 / verotoxin
In the large intestine
Watery bloody diarrhea - dysentery
Dehydration
NO fever
HEMOLYTIC UREMIC SYNDROME(usually immunocompromised)
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Enteroinvasive Ecoli
Found in natural for gut
Occurs sporadically by invasion directly to the intestinal epithelium and formation of enterotoxins
In the large intestine
Watery then leads to bloody diarrhea with mucous (dysentery similar to shigella) Fever Chills Abdominal cramps Vomiting
Diagnosis of ecoli
Fecal stool Culture in sorbitol McConkey agar
Form green colonies with metallic sheen on Epsom methylene blue agar
Enterohemorrhagic- serotype 0157:H7
Via enzyme immuno assay
Treatment for ecoli
Start rehydration IV fluid
Patient should return to normal diet as soon as possible
Antibiotics is not recommended conferred only in severe and persistent cases -
In that case - azithromycin
Or fluroquinilones - second line
Enterotoxigenic
Antibyiocs may shorten the symptom duration
Bismuth - decrease frequency Of bowel movements
Enterohemorrhagic
ANTIBIOTICS CONTRAINDICATED
