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Acute Infectious Diarrhea Flashcards

1
Q

Is the second most common infectious cause of death among children < 5 yrs old. (Harrison pp 852)

A

Diarrhea

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2
Q

Recurrent Intestinal infections are associated with the following: (Harrison pp 852)

A

Physical and Mental stunting
Wasting
Micronutrient deficiencies
Malnutrition

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3
Q

What are the pathogenic mechanisms involved in diarrhea? (Harrison pp 852)

A

Inoculum size
Adherence
Toxin production
Invasion

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4
Q

In non-inflammatory causes of acute diarrhea, which part of the intestine is involved? (Harrison pp 852)

A

Proximal small bowel

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5
Q

Non-inflammatory causes of acute diarrhea (Harrison pp 852)

A 
Vibrio cholerae
Enterotoxigenic E. Coli
Enteroaggregative E. Coli
Clostridium perfringes 
Bacillus cereus
Staphylococcus aureus
Aeromonas hydrophilia
Rotaviras, norovirus
Giardia lamblia
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6
Q

What is the stool findings in inflammatory cause of acute diarrhea? (Harrison pp 852)

A

Fecal polymorphonuclear leukocytes

INCREASE in fecal lactoferrin

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7
Q

What is the stool findings in non-inflammatory cause of acute diarrhea? (Harrison pp 852)

A

No fecal leukocytes

No or mild increase in lactoferrin

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8
Q

Enterohemorrhagic E. coli causes what disease? (Harrison pp 852)

A

Hemorrhagic colitis

Hemolytic uremic syndrome

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9
Q

Enterotoxin acts directly on _____ in the intestinal mucosa (Harrison pp 852)

A

Secretory mechanism

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10
Q

It is a toxin production that causes destruction of mucosal cells and associated inflammatory diarrhea (Harrison pp 853)

A

Cytotoxins

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11
Q

Acts directly on the central and peripheral nervous system (Harrison pp 853)

A

Neurotoxins

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12
Q

It is a heterodimeric protein (1 unit A, 5 units B) and prototypical enterotoxin (Harrison pp 853)

A

Cholera toxins

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13
Q

It is a syndrome characterized by fever, headache, relative bradycardia and abdominal pain, splenomegaly and leukopenia. (Harrison pp 853)

A

Enteric Fever

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14
Q

Common practices that increases the risk of enteric colonization (Harrison pp 853)

A

Antacids
Proton pump inhibitors
H2 blockers

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15
Q

It is the major mechanism for clearance of bacteria from the proximal small intestines (Harrison pp 853)

A

Normal peristalsis

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16
Q

It is the 1st line defense against many gastrointestinal pathogens. (Harrison pp 853)

A

Mucosal immune system

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17
Q

Blood type O show increased susceptibility to the following bacteria: (Harrison pp 853)

A 
E. coli VS Norovirus
E. coli O157
Vibrio cholerae
Shigella 
Norovirus
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18
Q

Signs of MILD dehydration (Harrison pp 853)

A 
Thirst 
Dry mouth 
Decreased axillary sweat
Decreased urine output 
Slight weight loss
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19
Q

Signs of MODERATE dehydration (Harrison pp 853)

A

SOS
Skin tenting
Orthostatic fall in blood pressure
Sunken eyes

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20
Q

Signs of SEVERE dehydration (Harrsion pp 853)

A 
Lethargy
Obtundation 
Feeble pulse 
Hypotension 
Frank shock
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21
Q

How many weeks should be counted as chronic? (Harrison pp 854)

22
Q

When is advisable to obtain stools for parasites? (Harrison pp 854)

23
Q

Bloody stools WITHOUT fecal leuckocytes (Harrison pp 854)

A

Enterohemorrhagic Escherichia Coli

24
Q

Painful rectal spasms with a strong urge to defecate but little passage of stools (Harrison pp 854)

25
It is a marker of fecal leukocytes and more sensitive and available in latex agglutination (Harrison pp 854)
Fecal lactoferrin
26
Post - diarrhea complications (Harrison pp 855)
``` Chronic diarrhea (Lactase deficiency, Small bowel bacterial overgrowth, Malabsorption) IBS Reactive Arthritis Hemolytic Uremic Syndrome Gullain Barre Syndome ```
27
What compromise Hemolytic Uremic Syndrome?(Harrison pp 855)
Hemolytic Anemia Thrombocytopenia Renal Failure
28
What organisms involved in Reactive arthritis? (Harrison pp 855)
Shigella Salmonella Campylobacter Yersinia
29
It is the most common travel-related infectious illness (Harrsion pp 855)
Traveler's diarrhea
30
It is the most common etiologic agent associated with outbreaks of acute gastroenteritis. (Harrison pp 855)
Norovirus
31
It is identified as cause of antibiotic associated hemorrhagic colitis. (Harrison pp 855)
Klebsiella oxytoca
32
It is the major cause of dysentery (Harrison pp 855)
Shigella
33
It is the emerging enteric pathogen with worldwide distribution (Harrison pp 855)
Enteroaggregative E. coli
34
It affects the hikers and campers (Harrison pp 855)
Giardia lambia
35
Bacteria that is resistant to chlorine treatment (Harrison pp 855)
Cryptosporidium
36
They are particularly at risk of C. difficile colitis and Giardiasis. (Harrison pp 855)
Hypogammaglobulinemia
37
It is commonly found at fried rice. (Harrison pp 856)
Bacillus aureus
38
It is found in egg salad, dairy products (mayonnaise) and poultry (Harrison pp 856)
``` Staphylococcus aureus (1-6 hrs of incubations) Salmonella spp. (> 16 hours of incubations) ```
39
It caused abdominal cramps and found in legumes and gravies (Harrison pp 856)
Clostridium perfringens (8-16 hrs of incubations)
40
It is found in Mollusks and crustaceans (Harrison pp 856)
Vibrio parahaemolyticus (> 16 hrs)
41
Bacillus cereus can produce short incubation and also long incubation syndrome. What are those two types of form? (Harrison pp 856)
Emetic form | Diarrheal form
42
What culture should be used in Cholera? (Harrison pp 856)
Thiosulfate-citrate-bile-salts-sucrose agar or Tellurite -taurocholate-gelatin (TTG) agar
43
True or False: All patient with fever and evidence of inflammatory disease acquired outside the hospital should have stool cultured for Salmonella, Shigella and Campylobacter. (Harrison pp 856)
True
44
What is the main stay treatment for diarrhea? (Harrison pp 856)
Adequate hydration
45
What is "Reduced-osmolality/reduced salt" that is recommended by the WHO? (Harrison pp 856)
2. 6g (3.5): Sodium chloride 2. 9g: Trisodium citrate/ Na Bicarbonate 1. 5 g: Potassium chloride 13. 5g (20g): Glucose
46
Suggested therapy for watery diarrhea without distressing enteric symptoms (Harrison pp 857)
ORS and saltine crackers
47
Suggested therapy for watery diarrhea (1-2 stools per day) with distressing enteric symptoms. (Harrison pp 857)
ADULTS: 1. Bismuth subsalicylate 2 tabs (262mg/tab) every 30 min for 8 doses 2. Loperamide 4mg initially followed by 2mg after passage of each unformed stools, NOT to exceed 8 tablets.
48
Suggested therapy for watery diarrhea with 2 or more unformed stools per day (Harrison pp 857)
Antibacterial plus loperamide
49
Dysentery or Fever of >37.8 (Harrison pp 857)
Antibacterial | NO loperamide for fever or with dysentery
50
If with low suspicion for fluoroquinolone-resistant campylobacter what antibiotics should be started? (Harrison pp 857)
Fluoroquinolones: Ciprofloxacin 750mg as single dose OR 500mg BID for 3 days; Levofloxacin 500mg as single dose or 500mg OD for 3 days; Norfloxacin 800mg as single dose or 400mg BID for 3 days Macrolides: Azithromycin 1000mg as single dose or 500mg OD for 3 days Rifaximin 200mg TID or 400mg BID for 3 days (It is not recommended for dysentery
51
Why is not recommended to start antimicrobial therapy for Enterohemorrhagic E. coli infections? (Harrison pp 857)
Antibiotics induced replications of Shiga toxin producing lambdoid bacteriophages (STEC) and 20x increases the risk of HUS
52
Adverse effect of bismuth subsalicylate (Harrison pp 857)
Darkening of the tongue | Tinnutus

Infectious (7 decks)

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