53. Bacterial Diarrhea Flashcards
What is diarrhea?
change in consistency/frequency of stools
secretion>absorption
impt questions for patient w/diarrhea ?
duration, character, associated sxs
travel history
Abx use
Ill contacts - suspected source
PMH - IBD? Celiacs?
a physical exam for a pt w/diarrhea should focus on what?
dehydration
ie orthostatics, dehydration degree w/lack of turgor, dry mucous membranes, no tears w/crying
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
S.aureus
features of acute gastroenteritis?
sudden onset
short duration
common source
prominent vomiting
etiologies of acute gastroenteritis?
preformed toxins:
- S. aureus
- C. perfringens
- Bacillus cereus
viruses
Management of Acute Gastroenteritis?
- eval level of hydration and IV rehydration PRN
- anti-emetics and antimotility agents for sxs relief
Acute watery diarrhea features?
cramps, vomiting variable
fever not prominent
no mucous or blood in stools
etiologies of acute watery diarrhea?
- viruses
- ETEC, EAEC, EPEC
- V.cholerae
- Campylobacter, salmonella, shigella, EIEC
- parasites
Tx of acute watery diarrhea?
ORS, lactoferrin test/leukocyte test of stools
acute inflammatory diarrhea features?
- cramps, abd pain prominen
- fever present
- stool w/mucous +/- blood
dysentery: frequent low volume bowel movements w/blood +/- mucous and tenesmus
etiologies of acute inflammatory diarrhea?
- C.diff
- Campylobacter, Salmonella, Shigella, EHEC, EIEC, Yersinia
- parasites
dysentery: shigella and ameboae
what pts w/diarrhea get a culture?
- immunocompromised
- outbreak
- dysentery
- cholera suspected
- duration >24 hours w/positive leukocytes or lactoferrin stool sample
tx for confirmed shigella?
empiric: ciprofloxacin or azithromycin
check susceptibilities, resistance common….if resistant to ^^^ then use TMP-SMX, if still resistant, use IV ceftriaxone
tx for confirmed C.diff?
metronidazole, oral vancomycin if severe
fidaxomicin (expensive)
tx for suspected v.cholerae?
ORS or IV fluids
resistance common but for severe disease use doxycycline, azithromycin or ciprofloxacin
tx of acute inflammatory diarrhea prior to confirmation?
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
tx for traveler’s diarrhea?
loperamide and if doesn’t respond use ciprofloxacin or rifamixin
