84. Gastroenteritis Flashcards
RFs
Travel camping recent abx daycare raw seafood anal sex HIV + outbreaks
Indications to order labs
o fever
o bloody
o severe abdo pain
o persistent diarrhea
indications for stool Cx
o fever > 38.5 o dysentery o > 14 days o Recent Abx o Immunocompromised
Indication for O+P
persistent diarrhea
4 most common bacteria
campylobacter, salmonella, STEC, shigella
signs of invasive infection
o Fever
o Blood
o Tenesmus
o Severe abdo pain
source of campylobacter
- More common in summer
- Gr- bacteria
- Undercooked poultry
- Wilderness water
MGMT campylobacter
- No empiric Abx if otherwise healthy
- Exception is traveler
- If not improving
o Erythro or azithro
o Cipro has high resistance now
source of salmonella
- Contaminated food
o Poultry and beef - Must ingest large amount of bacteria
MGMT salmonella
- No empiric Abx if otherwise healthy
o Possible for <3mon and > 50yo - Cipro or azithro
- If require hospitalization, then ceftriaxone
- No food handling until carrier state eradicated
source of shigella
- Most common in poor sanitation countries
- Penal and nursing homes
- <5yo are 30% of cases
- MSM
- Requires very few bacteria
MGMT shigella
- Fluids and lyte correction
- No need to Abx unless public health risk
- Abx shorten clinical course within 48 hours
o Cipro is drug of choice
source of yersina
- Gr- bacterium
- More common in children
- Invades mucosa and localizes to lymphoid tissue
- Invasive in 2/3
- From contaminated food or milk
MGMT yersina
- Usually self limited
- No anti-peristaltic unless abx
- No Abx if uncomplication
- Usually susceptible to TMP-SMX
source of vibrio
raw fish in tropical waters
MGMT vibrio
Most need none
no antimotility agents
source of STEC
undercooked hamburger
complication of STEC
o TTP Neuro findings predominate Renal failure uncommon o HUS Renal failure
MGMT STEC
- Symptomatic
- Abx not helpful and can worsen risk of HUS
- Only Abx if fever > 38.5
source of staph
- Most protein rich food have some
- Large outbreaks common worldwide
- Bacteria killed above 60C, but toxin is heat stable
MGMT staph
- Rapid recovery is the rule
- Antiemetics
- IVF
- No Abx
source of clostridium
- Common in large groups
- Meat or poultry
- Usually cooked food that was rewarmed poorly
- Illness caused by toxins
mgmt clostridium
supportive
source of baccilus cereus
- 2 forms Emetic Heat stable toxin Fried rice Diarrheal Meat and veggies
MGMT cereus
supportive
source of ETEC
fecal contamination of food
MGMT ETEC
nothing for most
single dose cipro+loperamide
complications for cdiff
pseuodmembrane
toxic megacolon
perfs
MGMT c diff
- DC Abx
- Flagyl for 10-14 days for mild to moderate
- Vanco for severe
labs signs for toxic megacolon
older, immunosuppressed and have WBC >20
source of norovirus
fecal oral
highly infectious
MGMT of rotavirus
supportive
vaccine
MGMT norovirus
supportive
source of giardia
- Both active and inactive forms
- Infection through active form, spread through inactive form
- Contaminated food and water
- Common in hikers
MGMT giardia
flagyl
source of amebiasis
- Developing countries and poor sanitation
- Cysts can survive in environment for months
- Fecal oral food or anal-oral sex
MGMT amebiasis
flagyl
