53. Bacterial Diarrhea

Question 1

What is diarrhea?

Answer 1

change in consistency/frequency of stools

secretion>absorption

Question 2

impt questions for patient w/diarrhea ?

Answer 2

duration, character, associated sxs

travel history

Abx use

Ill contacts - suspected source

PMH - IBD? Celiacs?

Question 3

a physical exam for a pt w/diarrhea should focus on what?

Answer 3

dehydration

ie orthostatics, dehydration degree w/lack of turgor, dry mucous membranes, no tears w/crying

Question 4

A 27 y/o woman w/sudden onset severe nausea followed by vomiting and watery diarrhea. Multiple bouts of vomiting and diarrhea x 18 hours. Husband has similar sxs starting 2 hours after her illness. Recover w/in 24 hours.

Most likely bacteria?
a. C. jejuni
B. E.coli
c. Salmonella enterica
d S.aureus
e. V.cholerae

Answer 4

S.aureus

Question 5

features of acute gastroenteritis?

Answer 5

sudden onset

short duration

common source

prominent vomiting

Question 6

etiologies of acute gastroenteritis?

Answer 6

preformed toxins:

• S. aureus
• C. perfringens
• Bacillus cereus

viruses

Question 7

Management of Acute Gastroenteritis?

Answer 7

• eval level of hydration and IV rehydration PRN

- anti-emetics and antimotility agents for sxs relief

Question 8

Acute watery diarrhea features?

Answer 8

cramps, vomiting variable

fever not prominent

no mucous or blood in stools

Question 9

etiologies of acute watery diarrhea?

Answer 9

• viruses
• ETEC, EAEC, EPEC
• V.cholerae
• Campylobacter, salmonella, shigella, EIEC
• parasites

Question 10

Tx of acute watery diarrhea?

Answer 10

ORS, lactoferrin test/leukocyte test of stools

Question 11

acute inflammatory diarrhea features?

Answer 11

• cramps, abd pain prominen
• fever present
• stool w/mucous +/- blood

dysentery: frequent low volume bowel movements w/blood +/- mucous and tenesmus

Question 12

etiologies of acute inflammatory diarrhea?

Answer 12

• C.diff
• Campylobacter, Salmonella, Shigella, EHEC, EIEC, Yersinia
• parasites

dysentery: shigella and ameboae

Question 13

what pts w/diarrhea get a culture?

Answer 13

• immunocompromised
• outbreak
• dysentery
• cholera suspected
• duration >24 hours w/positive leukocytes or lactoferrin stool sample

Question 14

tx for confirmed shigella?

Answer 14

empiric: ciprofloxacin or azithromycin

check susceptibilities, resistance common….if resistant to ^^^ then use TMP-SMX, if still resistant, use IV ceftriaxone

Question 15

tx for confirmed C.diff?

Answer 15

metronidazole, oral vancomycin if severe

fidaxomicin (expensive)

Question 16

tx for suspected v.cholerae?

Answer 16

ORS or IV fluids

resistance common but for severe disease use doxycycline, azithromycin or ciprofloxacin

Question 17

tx of acute inflammatory diarrhea prior to confirmation?

Answer 17

ciprofloxacin, TMP-SMX, or rifamixin but,,,

BEWARE! if suspect SALMONELLA, don’t use abx because prolongs duration, prolongs carrier state, and assoc w/symptomatic relapse. If blood in stool may suspect EHEC, don’t use abx re: increased risk of HUS

DON’T treat campylobacter if >3 days

Question 18

tx for traveler’s diarrhea?

Answer 18

loperamide and if doesn’t respond use ciprofloxacin or rifamixin