Acute Diarrhea (With or Without Vomiting) Flashcards
What are the causative organisms of Acute Diarrhea (With or Without Vomiting)?
Bacterial Causes Salmonella Shigella Shiga-toxin-producing E. coli (O157:H7 and others) Other E. coli (non-shiga-toxin-producing) Campylobacter Clostridiodies difficile Vibrio cholerae Non-cholera Vibro species
Non-Bacterial Causes
Cryptospordium
Rotavirus
Norovirus
What form of Acute Diarrhea is Samonella?
Bacterial, gram-negative
What are the most common modes of transmission for Acute Diarrhea (Salmonella)?
Vehicle (food, beverage), fecal-oral
What are the virulence factors for Acute Diarrhea (Salmonella)?
Adhesins, endotoxin
How do you culture/diagnose Acute Diarrhea (Salmonella)?
Stool culture, not usually necessary
How do you prevent Acute Diarrhea (Salmonella)?
Food hygiene and personal hygiene
How do you treat Acute Diarrhea (Salmonella)?
Rehydration; no antibiotic for uncomplicated diseases; in complicated disease ciprofloxacin; resistant Salmonella is considered a Serious Threat by the CDC
Is fever present for Acute Diarrhea (Salmonella)?
Usually
Is there blood in the stool for Acute Diarrhea (Salmonella)?
Sometimes
What are the distinctive features of Acute Diarrhea (Salmonella)?
Often associated with chickens, reptiles
What are the epidemiological features of Acute Diarrhea (Salmonella)?
United States: +/- 1.2 million cases/yr; 20% of all cases require hospitalization; death rate of 0.6%;
Category B Bioterriorism Agent
What are the epidemiological features of Acute Diarrhea (Salmonella)?
United States: +/- 1.2 million cases/yr; 20% of all cases require hospitalization; death rate of 0.6%;
Category B Bioterrorism Agent
What form of Acute Diarrhea is Shigella?
Bacterial; gram-negative
What are the most common modes of transmission for Acute Diarrhea (Shigella)?
Fecal-oral, direct contact
What are the virulence factors for Acute Diarrhea (Shigella)?
Endotoxin, enterotoxin, shiga toxins in some strains
How do you culture/diagnose Acute Diarrhea (Shigella)?
Stool culture; antigen testing for shiga toxin
How do you prevent Acute Diarrhea (Shigella)?
Food hygiene and personal hygiene
How do you treat Acute Diarrhea (Shigella)?
Ciprofloxacin; drug-resistant Shigella is in the CDC’s Serious Threat category
is fever present with Acute Diarrhea (Shigella)?
Often
Is there blood in stool with Acute Diarrhea (Shigella)?
Often
What are the distinctive features of Acute Diarrhea (Shigella)?
Very low ID50
What are the epidemiological features of Acute Diarrhea (Shigella)?
United States: estimated 450,000 cases per year; internationally: 165 million cases per year;
Category B Bioterriorism agent
What form of Acute Diarrhea is Shiga-toxin-producing E. coli (O157:H7 and others)?
Bacterial, gram-negative
What are the most common modes of transmission for Acute Diarrhea (Shiga-toxin-producing E. coli)?
Vehicle (food, beverage), fecal-oral
What are the virulence factors for Acute Diarrhea (Shiga-toxin-producing E. coli)?
Shiga toxins; proteins for attachment, secretion, effacement
How do you culture/diagnose Acute Diarrhea (Shiga-toxin-producing E. coli)?
Stool culture, antigen testing for shiga toxin
How do you prevent Acute Diarrhea (Shiga-toxin-producing E. coli)?
Avoid live E. coli (cook meat and clean vegetables); stay aware of food recalls
How do you treat Acute Diarrhea (Shiga-toxin-producing E. coli)?
Antibiotics contraindicated, supportive measures
Is fever present with Acute Diarrhea (Shiga-toxin-producing E. coli)?
Often
Is blood in stool with Acute Diarrhea (Shiga-toxin-producing E. coli)?
Usually
What are the distinctive features of Acute Diarrhea (Shiga-toxin-producing E. coli)?
Hemolytic uremic syndrome (HUS)
What are the epidemiological features of Acute Diarrhea (Shiga-toxin-producing E. coli)?
Internationally: causes HUS in 10% of patients; 25% of HUS patients suffer neurological complications, 50% have chronic renal sequelae;
Category B Bioterrorism Agent
What form of Acute Diarrhea is Other E. coli (non-shiga-toxin-producing)?
Bacterial, gram-negative
What are the most common form of transmission for Acute Diarrhea (Other E. coli- non-shiga-toxin-producing)?
Vehicle, fecal-oral
What are the virulence factors for Acute Diarrhea (Other E. coli- non-Shiga-toxin-producing)?
Various: proteins for attachment, secretion, effacement; heat-labile and/or heat-stable exotoxins; invasiveness
How do you culture/diagnose (Other E. coli- non-Shiga-toxin-producing)?
Stool culture not usually necessary in absence of blood, fever
How do you prevent (Other E. coli- non-Shiga-toxin-producing)?
Food and personal hygiene
How do you teat (Other E. coli- non-Shiga-toxin-producing)?
Rehydration, antimotility agent
is fever present with (Other E. coli- non-Shiga-toxin-producing)?
Sometimes
Is there blood in the stool with (Other E. coli- non-Shiga-toxin-producing)?
Sometimes
What are the distinctive features of (Other E. coli- non-Shiga-toxin-producing)?
ETEC, EIEC, EPEC, DAEC, EAEC
What are the epidemiological features of fever, abdominal cramps, and bloody diarrhea (Other E. coli- non-Shiga-toxin-producing)?
What form of Acute Diarrhea is Campylobacter?
Bacterial, gram-negative
What are the most common modes of transmission for Acute Diarrhea (Campylobacter)?
Vehicle (food, water), fecal-oral
What are the virulence factors for Acute Diarrhea (Campylobacter)?
Adhesins, exotoxin, induction of autoimmunity
How do you culture/diagnose Acute Diarrhea (Campylobacter)?
Stool culture not usually necessary; dark-field microscopy
How do you prevent Acute Diarrhea (Campylobacter)?
Food and personal hygiene
How do you treat Acute Diarrhea (Campylobacter)?
Rehydration; azithromycin in severe cases (antibiotic resistance rising; resistant Campylobacter is in CDC’s Serious Threat category)
Is there a fever present with Acute Diarrhea (Campylobacter)?
Usually
Is there blood in the stool with Acute Diarrhea (Campylobacter)?
No
What are the distinctive features of Acute Diarrhea (Campylobacter)?
Gullian-Barre syndrome
What are the epidemiological features of Acute Diarrhea (Campylobacter)?
United States: 1.3 million cases per year; internationally: 400 million cases per year
What form of Acute Diarrhea is Clostridiodes difficile?
Bacterial, gram-positive
What are the most common modes of transmission for Acute Diarrhea (Clostridiodies difficile)?
Endogenous (normal biota)
What are the virulence factors for Acute Diarrhea (Clostridiodies difficile)?
Enterotoxins A and B
How do you culture/diagnose Acute Diarrhea (Clostridiodies difficile)?
Stool culture, PCR, ELISA demonstration of toxins in stool
How do you prevent Acute Diarrhea (Clostridiodies difficile)?
How do you treat Acute Diarrhea (Clostridiodies difficile)?
Metronidazole in mild cases; vancomycinn for severe; fecal transplants; resistant strains are in the CDC’s Urgent Threat category
Is there a fever with Acute Diarrhea (Clostridiodies difficile)?
Sometimes
Is there blood in the stool with Acute Diarrhea (Clostridiodies difficile)?
Not usually; mucus prominent
What are the distinctive features of Acute Diarrhea (Clostridiodies difficile)?
Associated with disruption of normal biota
What are the epidemiological features of Acute Diarrhea (Clostridiodies difficile)?
United States: 500,000 cases per year
What form of Acute Diarrhea is Vibrio cholerae?
Bacterial, gram-negative
What are the most common modes of transmission for Acute Diarrhea (Vibrio cholerae)?
Vehicle (water and some foods), fecal-oral
What are the virulence factors for Acute Diarrhea (Vibrio cholerae)?
Cholera toxin (CT)
How do you culture/diagnose Acute Diarrhea (Vibrio cholerae)?
Clinical diagnosis, microscopic techniques, serological detection of antitoxin
How do you prevent Acute Diarrhea (Vibrio cholerae)?
Water and food hygiene
How do you treat Acute Diarrhea (Vibrio cholerae)?
Rehydration and possibly doxycycline
is there a fever present with Acute Diarrhea (Vibrio cholerae)?
No
Is there blood in the stool with Acute Diarrhea (Vibrio cholerae)?
NO
What are the distinctive features of Acute Diarrhea (Vibrio cholerae)?
Rice-water stools
What are the epidemiological features of Acute Diarrhea (Vibrio cholerae)?
Global estimate: 21,000 to 143,000 deaths annually
Category B Bioterrorism Agent
What form of Acute Diarrhea is Non-cholera Vibrio species?
Bacterial, gram-negative
What are the most common modes of transmission for Acute Diarrhea (Non-cholera Vibro species)?
Vehicle (food or natural bodies of water)
What are the virulence factors for Acute Diarrhea (Non-cholera Vibro species)?
–
How do you culture/diagnose Acute Diarrhea (Non-cholera Vibro species)?
Culture of stool or blood
How do you prevent Acute Diarrhea (Non-cholera Vibro species)?
Avoiding raw shellfish
How do you treat Acute Diarrhea (Non-cholera Vibro species)?
Doxycycline
Is there a fever with Acute Diarrhea (Non-cholera Vibro species)?
Yes
Is there blood in stool with Acute Diarrhea (Non-cholera Vibro species)?
NO
What are the distinctive features of Acute Diarrhea (Non-cholera Vibro species)?
Sepsis can follow
What are the epidemiological features of Acute Diarrhea (Non-cholera Vibro species)?
Cause 90% of seafood-related deaths in United States
What form of Acute Diarrhea is Cryptosporidium?
Parasite
What are the most common modes of transmission for Acute Diarrhea (Cryptosporidium)?
Vehicle (water, food), fecal-oral
What are the virulence factors for Acute Diarrhea (Cryptosporidium)?
Intracellular growth
How do you culture/diagnose Acute Diarrhea (Cryptosporidium)?
Acid-fast staining, ruling out bacteria
How do you prevent Acute Diarrhea (Cryptosporidium)?
Water treatment, proper food handling
How do you treat Acute Diarrhea (Cryptosporidium)?
None or nitazoxanide in immunocompetent patients
Is there a fever associated with Acute Diarrhea (Cryptosporidium)?
Often
Is there blood in stool with Acute Diarrhea (Cryptosporidium)?
Not usually
What are the distictive features of Acute Diarrhea (Cryptosporidium)?
Resistant to chlorine disinfection
What are the epidemiological features of Acute Diarrhea (Cryptosporidium)?
United States: estimated 748,000 cases per year; 30% seropositive;
Category B Bioterrorism Agent
What form of Acute Diarrhea is Rotavirus?
Virus
What are the most common modes of transmission for Acute Diarrhea (Rotavirus)?
Fecal-oral, vehicle, formite
What are the virulence factors for Acute Diarrhea (Rotavirus)?
–
How do you culture/diagnose Acute Diarrhea (Rotavirus)?
Rapid antigen test
How do you prevent Acute Diarrhea (Rotavirus)?
Oral live-virus vaccines
How do you treat Acute Diarrhea (Rotavirus)?
Rehydration
Is there a fever associated with Acute Diarrhea (Rotavirus)?
Often
Is there blood in stool with Acute Diarrhea (Rotavirus)?
No
What are the distinctive features of Acute Diarrhea (Rotavirus)?
Severe in infants
What are the epidemiological features of Acute Diarrhea (Rotavirus)?
United States: 2 to 3 million cases per year; internationally: 125 million cases of infantile diarrhea annually
What form of Acute Diarrhea is Norovirus?
Virus
What are the most common modes of transmission for Acute Diarrhea (Norovirus)?
Indirect, vehicle (food), direct contact
What are the virulence factors for Acute Diarrhea (Norovirus)?
Limited immunity to reinfection
How do you culture/diagnose Acute Diarrhea (Norovirus)?
Rapid antigen test
How do you prevent Acute Diarrhea (Norovirus)?
Hygiene
How do you treat Acute Diarrhea (Norovirus)?
Rehydration
Is there a fever associated with Acute Diarrhea (Norovirus)?
Sometimes
Is there blood in stool with Acute Diarrhea (Norovirus)?
No
What are the distinctive features of Acute Diarrhea (Norovirus)?
Resistant to disinfection
What are the epidemiological features of Acute Diarrhea (Norovirus)?
United States: second most common cause of foodborne illness hospitalization