Acute Diarrhea (With or Without Vomiting) Flashcards by Hope Bowen

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

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What form of Acute Diarrhea is Samonella?

Bacterial, gram-negative

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What are the most common modes of transmission for Acute Diarrhea (Salmonella)?

Vehicle (food, beverage), fecal-oral

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What are the virulence factors for Acute Diarrhea (Salmonella)?

Adhesins, endotoxin

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How do you culture/diagnose Acute Diarrhea (Salmonella)?

Stool culture, not usually necessary

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How do you prevent Acute Diarrhea (Salmonella)?

Food hygiene and personal hygiene

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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

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Is fever present for Acute Diarrhea (Salmonella)?

Usually

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Is there blood in the stool for Acute Diarrhea (Salmonella)?

Sometimes

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What are the distinctive features of Acute Diarrhea (Salmonella)?

Often associated with chickens, reptiles

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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

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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

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What form of Acute Diarrhea is Shigella?

Bacterial; gram-negative

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What are the most common modes of transmission for Acute Diarrhea (Shigella)?

Fecal-oral, direct contact

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What are the virulence factors for Acute Diarrhea (Shigella)?

Endotoxin, enterotoxin, shiga toxins in some strains

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How do you culture/diagnose Acute Diarrhea (Shigella)?

Stool culture; antigen testing for shiga toxin

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How do you prevent Acute Diarrhea (Shigella)?

Food hygiene and personal hygiene

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How do you treat Acute Diarrhea (Shigella)?

Ciprofloxacin; drug-resistant Shigella is in the CDC’s Serious Threat category

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is fever present with Acute Diarrhea (Shigella)?

Often

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Is there blood in stool with Acute Diarrhea (Shigella)?

Often

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What are the distinctive features of Acute Diarrhea (Shigella)?

Very low ID50

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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

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What form of Acute Diarrhea is Shiga-toxin-producing E. coli (O157:H7 and others)?

Bacterial, gram-negative

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What are the most common modes of transmission for Acute Diarrhea (Shiga-toxin-producing E. coli)?

Vehicle (food, beverage), fecal-oral

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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)?

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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)?

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)?

Is there blood in the stool with Acute Diarrhea (Vibrio cholerae)?

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)?

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)?

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)?

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