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GI2 E1 > acute infectious diarrhea > Flashcards

acute infectious diarrhea Flashcards

clin med

1
Q

major cause of death in infectious diarrhea

A

dehydration

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2
Q

sx of enterotoxin-producing bacterial infection

A

small bowel hypersecretion –>

profuse, watery diarrhea
marked vomiting
min fever
occurs abruptly within a few hours after ingestion

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3
Q

sx of enteroadherant pathogens causing infectious diarrhea

A

small bowel hypersecretion–>

mild vomiting
high levels of abd cramping + bloating
high fever

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4
Q

sx of cytotoxin producing and invasive microorganisms causing infectious diarrhea

A

high fever

abd pain

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5
Q

5 high risk groups for infectious diarrhea

A 
travelers
immunodeficient
daycare families 
institutionalized (assisted living)
consumers of certain foods
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6
Q

what agents are daycare workers/attendees/ and families especially at risk of being infected by

A

shigella
giardia
cryptosporidium
rotavirus

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7
Q

signs of mild, mod, and severe dehydration

A

mild= thirs, dry mouth, less sweating and urination, weight loss

mod= orthostatic fall in BP, skin tenting, sunken eyes

severe= lethargy, obtundation, feeble pulse, hypotension, shock

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8
Q

most cases of acute infectious diarrhea are ___ and ____, so you ____ do an extensive work up

A

mild
self-limited
dont need to

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9
Q

explain the steps in treating infectious diarrhea

A

first find if it is likely infectious
(Y or N, still treat w fluid and electrolyte replacement)

if mild diarrhea, just observe until further proof
(then trx with plan for severe)

if mod diarrhea, but not other systemic sx then just give them antidiarrheal agents

if severe OR mod with (F>38,bloody stools, increased fecal WBC, x immunity, or old person) OR persistent mild diarrhea—> get a stool study and treat w specific/empirical trx

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10
Q

indications for evaluation of infectious diarrhea

A 
profuse with dehydration
hypotension and tachy not responsive to volume repletion
dysentery
fever > 38.5
duration >48 hrs w no improve
recent abx use (bc c dif)
severe abd pain
>70
immunocompromised
cr > 1.5xnormal
peripheral leukocytes >15k
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11
Q

what organisms can be caught on a routine stool culture

A

salmonella
shigella
E. Coli
campylobacter

takes 24-48 hours

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12
Q

what organisms do you need to specifically get a stool bacterial culture to be able to see?

A

EHEC E Coli (specifically ask for shiga like toxin)
vibrio
yersinia

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13
Q

what organisms do you need to specifically get a stool immunoassay to be able to see?

A

C. Dif PCR/toxin

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14
Q

what organisms do you need to specifically get a stool protozoal Ag to be able to see?

A

giardia
cryptosporidium
E. hystolitica

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15
Q

what organisms do you need to specifically get a stool viral PCR/Ag to be able to see?

A

rotovirus

norwalk/norovirus

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16
Q

if stool studies are unrevealing for infectious diarrhea, what can you do next

A

endoscopy w biopsy

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17
Q

why should you order an xray with infectious diarrhea

A

with an abd xray you can check for free intraperitoneal air, ileus, or toxic megacolon, all of which could be complications of bacterial infection

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18
Q

what time of year and what situational context should make you consider bacterial diarrhea/food poisoning

A

summer time, food be sitting out a long time

after multiple illnesses reported after a shared meal

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19
Q

what bacterial agents can be caused by eating infected chicken

A

salmonella
campylobacter
shigella

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20
Q

what bacterial agents can be caused by eating infected undercooked hamburger

A

EHEC

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21
Q

what bacterial agents can be caused by eating infected fried rice

A

bacillus cereus

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22
Q

what bacterial agents can be caused by eating infected potato salad, mayo, or cream pastries

A

staph aureus

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23
Q

what bacterial agents can be caused by eating infected eggs

A

salmonella

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24
Q

what bacterial agents can be caused by eating infected lunch meat, soft cheese

A

listeria

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25
Q

what bacterial agents can be caused by eating infected seafood

A

vibrio, salmonella, acute Hep A, norovirus, campylobacter

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26
Q

what bacterial agents can be caused by eating infected beef, ham, legumes, gravy

A

C. perfringens

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27
Q

microbio of staph aureus

A

G+ cluster, has preformed enterotoxins

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28
Q

sx and trx of staph aureus infectious diarrhea

A

N/V, watery diarrhea, within 6 hours of ingestion

trx= rapid resolution within 1-2 days

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29
Q

microbio of bacillus cereus

A

G+ rods, preformed enterotoxins

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30
Q

sx and trx of bacillus cereus infectious diarrhea

A

mainly vomiting, some watery diarrhea within 6 hours of ingestion

trx= rapid resolution within 1-2 days

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31
Q

microbio of C perfringens

A

G+, heat resistant spore forming Rod

preformed enterotoxins

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32
Q

sx and trx of C. Perfringens

A

watery diarrhea and cramping abd pain, onset within 8-16 hours of ingestion

trx= rapid resolution with 1-2 days

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33
Q

most common type of shigella in the US

A

shigella sonnei, subgroup D

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34
Q

classic cause of dysentery:

beginning with watery diarrhea w blood and pus—> bloody diarrhea

A

shigella

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35
Q

sx and diagnostic tools for shigella

A

watery diarrhea —> dysentery
small volume diarrhea
abd cramps
fever 3-4 days

dx= + fecal leukocytes, stool cultures ~ to IBD, lactose -

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36
Q

trx for shigella

A

bismuth, ampicillin, flouroquinolones, or trimethoprim/sulfamethoxazole

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37
Q

sx of salmonella typhimurium

A

watery –> bloody diarrhea, 5-10 days

fever, abd cramping, N/V, fecal leukocytes (+)

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38
Q

trx for salmonella typhimurium

A

is self limited to 5-10 days and abx not indicated

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39
Q

reptile exposure (spec. = turtles) can lead to infectious diarrhea caused by

A

salmonella typhimurium

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40
Q

what are the two sx phases in typhoid fever

A
  1. sustained febrile illness, 103-104 w weakness, HA, anorexia, “pea soup”, foul-smelling diarrhea –> bloody diarrhea, rose colored spots on skin

asx hitus

  1. bacteremia –>encephalopathy, splenomegaly, brady+dicrotic pulse, conjunctivitis, intestinal perforation, intestinal hemorrhage
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41
Q

dx and trx for salmonella typhi

A

ds= stool and blood cultures, fecal leukocytes +

trx= prevent with hand washing and good food prep
flouroquinolones, ceftriazone, azithromycin

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42
Q

sx of C. jejuni

A

watery–> bloody diarrhea
fever
crampy abd pain
erythema nodosum

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43
Q

microbio of C jejuni

A

G- curved/spiral shaped rod,

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44
Q

dx and trx of C jejuni

A

dx= fecal leukocytes +, stoolcultures NEED CAMPY BLOOD AGAR

trx= self limited to a 1 week, so just give supportive care

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45
Q

dx test for cholera

A

stool microscopy and gram stain

see rods darting around

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46
Q

what organism are you at risk of being infected by with raw oysters and/or salt water infected in sewage

A

cholera

virbio vulnificus

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47
Q

microbio of vibrio parahemolyticus

A

G- bacilli, cytotoxin production

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48
Q

sx of V. parahemolyticus

A

N/V, cramps, watery–>bloody diarrhea, 2-5 days

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49
Q

dx and trx of vibrio parahemolyticus

A

dx=fecal leukocyte +, stool culture request special

trx- self limited

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50
Q

microbio of vibrio vulnificus

A

G- bacillus

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51
Q

sx of vibrio vulnificus

A

= vomiting, diarrhea, abd pain within 16 hrs of ingestion

ballous skin lesions aka necrotic

is life threatening in an immunocompromised person, especially w cirrhosis and hemochromatosis

52
Q

microbio of A. hydrophila

A

G-, non-spore forming, rod shaped, motile

53
Q

sx of A. hydrophila

A

two types=
cholera like= watery rice water stools
or bloody mucoid stools

often wounded in fresh water env at the foot ankle, can rapidly progress to narcotizing fascitis

54
Q

trx for A. hydrophilia

A

ampicillin

55
Q

what is a classic presentation of someone with A. hydrophila

A

a scuba diver that swallows small amounts of fresh water and then has gastroenteritis

any fresh or brackish water, either eating fish or getting wounded in the water

56
Q

what risk factors can make someone vulnerable to contracting traveler’s diarrhea

A

H2 blocker/PPI

57
Q

most common pathogen for traveler’s diarrhea

A

ETEC

58
Q

infection commonly associated with visits to Russia, and campers

A

giardia

59
Q

infection commonly associated with cruise ships and daycares

A

norovirus

60
Q

microbio for ETEC

A

G- rod

61
Q

dx for ETEC

A

last 3-6 days

fecal leukocyte is (-)

diagnose clincally bc stool cultures don’t differentiate between strains of E. Coli

62
Q

trx for E Coli

A

abx that can reduce infection time

trimethoprim/sulfamethoxazole/doxycycline, ciproflaxaxin

63
Q

sx of EHEC infections

A

watery —> bloody diarrhea
acute hemorrhagic colitis
typically NO fever

64
Q

dx for EHEC and trx

A

CBC to check for leukocytes, anemia, thrombocytopenia

fecal leukocytes (+)

fecal lactoferrin (+)

trx= supportive care, rehydration, NO GIVE ABX or else get HUS only give abx if they’re actually about to die

65
Q

what populations have a high risk of yersinia infection

A

derangements of iron metabolism enhances virulence soo –> cirrhosis, hemochromatosis, aplastic anemia, thalassemia, DM

66
Q

microbio of listeria

A

G+, can grow in the cold

67
Q

risk factors for listeria infections

A

pregnancy
extremes of age and immunocompromised
contaminated deli meats

pregnant lady eats cheese

68
Q

dx and trx for listeria

A

need blood cultures

trx= ampicillin and TMP/SMX

69
Q

trx for T. whipplei (G+)

A

= whipple ds

abx therapy, prolonged trx for a year is required

cross the BBB- first cetriaxone, meropenem, followed by TMP/SMX

after trx, do repeated duodenal biopsies +spinal tap for at least a year to make sure its gone

70
Q

microbio of C. Dif

A

anaerobic, G+, spore forming bacillus that is exotoxin mediated

71
Q

dx for C. Dif

A

stool assay, PCR for toxin A or B
+ peripheral leukocytosis
pseudomembranes seen on sigmoidoscopy

72
Q

which drugs specifically have higher risk of C Dif infection

A

clindamycin
cephalosporins
flouroquinolone

73
Q

trx for c dif

A

PO/IV metronidazole

PO vancomycin

74
Q

what is a very serious complciation of c dif infection

A

toxic megacolon, with 60% mortality, needs aggressive trx and surgery consult

75
Q

most common nosocomial infections

A

C Dif, norovirus

76
Q

sx and stool findings in a case of proximal small bowel infection

A

watery diarrhea

(-) fecal leukocytes, no increase in fecal lactoferrin

77
Q

sx and stool findings in a case of colon or distal small bowel infection

A

dysentery/inflammatory diarrhea

fecal polymorphonuclear leukocytes
increase in fecal lactoferrin

78
Q

sx and stool findings in a case of distal small bowel infection

A

enteric fever

fecal mononuclear leukocytes`

79
Q

sx, dx, and trx for rotavirus

A

sx= [6 months–>2 year olds] vomiting and watery diarrhea –>severe dehydration
self limiting usually,

dx= (-) fecal leukocytes, detected by viral culture/PCP, ECM shows wagon wheel appearance

trx= support and vaccinate
dehydration–>death

80
Q

adenovirus population

A

children, second most common cause of gastroenteritis in children (after rota virus)

81
Q

sx, dx, and trx of adenovirus infection

A

high fever (103-104), myalgia, watery diarrhea, conjunctivitis, 10 day course, pharyngitis

dx= viral culture

trx- support

82
Q

population at risk for noro

A

older children and adults

83
Q

sx, dx, and trx for norovirus

A

sx= vomiting, watery diarrhea, lasting 3 days

dx= (-) fecal leukocytosis, routine viral cultures, need a work up

trx= supportive care

84
Q

population associated with CMV infection

A

immunosuppressed

85
Q

sx and dx of CMV

A

fever, blood diarrhea for several weeks

dx= endoscopy w biopsy of ulcerated lesions using CMV specific stains

86
Q

dx of E histolytica

A

flask shaped ulcer on histology,
stool for ova & parasite
stool Ag
fecal leukocytes (+)

acute narcotizing colitis

87
Q

trx for E. hystolytica

A

eliminate the invading trophozoites (metronidazole or tinidazole)

eradicate intestinal carriage –> paromomycin or iodoquinol

88
Q

microbio of giardia

A

pear shaped, 4 flagella

89
Q

sx, dx, and trx of giardia

A

sx= watery smelly diarrhea, weight gain, flatulence, steatorrhea, malase,

dx= fecal leukocytes (-), ova parasites, stool Ag detection

trx= tinidazole, metronidazole
recurrence is common

90
Q

clinical presentation of cryptosporidium parvum

A

in immunocomp ppl= self limited dairrhea (1-2 weeks(

in immunosuppressed, life threatening and possible indefinate

> 20 L of watery diarrhea a day

91
Q

what organism are you at risk of bring infected by in a public pool

A

cryptosporidium

92
Q

dx and trx of cryptosporidium

A 
dx= stool Ag or modified acid fast stainig, DFA (direc flourescence Ab)
fecal leukocytes (-)

trx= resistant to chlorine trx,
hydration,
loperamide, nitazoxsnide, trx AIDS if present

93
Q

those infected with HTLV-1 are more susceptible to infection by

A

strongyloides stercoralis

94
Q

sx, dx, and trx of strongyloides stercoralis

A

sx= often asx, or bloating, V/D, perianal urticaria, migratory rash

dx= rhabditiform larvae in stool

trx= anti-helmintic

95
Q

what organism are you at risk of bring infected by from imported produce (basil, raspberries)

A

cyclospora cayetanensis

96
Q

sx, dx, and trx of cyclospora cayetanensis

A

sx= low grade fever, watery dairrhea, anorexia lasting up to 21 days if immunocomp, indef if immunosupp

dx= fecal leukocyte (-), detect oocyte in stool

trx= TMP/SMX

97
Q

cystoisospara belli sx, dx, and trx

A

sx= acute watery diarrhea, crampy abd pain, malabsorption and weight loss
can be v severe in immunosupp, infants, and children

dx= repeated stool exams and concentrations, if (-) do a duodenal biopsy, visualize oocytes on wet mount or acid fast stain

trx= prevent, bactrim DS (TMP/SMX)

98
Q

soil transmitted hookwork that is ingested fromthe soil and can get really long to cause bowel obstruction

A

ascaris lumbricoides

99
Q

fish tapeworm from raw fish that can grow up to 30 ft and cause B12 deficiency

A

diphyllobothrium latum

100
Q

consequences of vit B12 deficiency

A

pernicious anemia and neuro sx

101
Q

most common infectious cause of esophageal varices in africa
most common cause of small portal V branch obstruction

method of infection and sx and trx

A

schistosoma mansoni

from contaminated freshwater snails, cause bloody stools, bladder CA and liver cysts

trx= praziquantel

102
Q

pork tapeworm, cause seizures and muscle or eye ds

A

taenia solium

103
Q

beef tapeworm, mostly asx

A

taenia saginata

104
Q

tapeworm from unsanitary sheep slaughter or dogs

complications

A

echinococcus granulosus

form cysts in liver or lungs
looks like free-flowing “hydatid sand” on CT

105
Q

E. vermicularis sx, dx, trx

A

(pinworm)
severe perianal itching

scotch tape test

trx= mebandazole

106
Q

when can anti-motility trx be used to treat infectious diarrhea

what two organisms can you NOT use anti-motility agents for

A

in patients with
NO fever
NON-bloody stools

C. dif and EHEC

107
Q

nutrition and diet recommendations for infectious diarrhea

A

BRAT diet (banana, rice, applesauce, toast)

easily digestible foods

rice water

avoid lactose and high fiber foods

108
Q

what two agents are hand sanitizer ineffective against

A

norovirus
c. dif

WASH YO HANDS BIOTCH

109
Q

what organisms can be vaccinated against

A

rotavirus

s. typhi
v. cholera

hep A

110
Q

what prophylaxis can be given to travelers to avoid travelers diarrhea

A

bismuth subsalicylate (s.e. of dark tongue and stools)

abx prohylaxis= cirprofloxacin, azithromycin, rifaximin

111
Q

what agents can cause reactive arthritis aka reiter’s syndrome

A

reiter’s syndrome= arthritis, urethritis, conjunctivitis (cant see, cant pee, can’t climb a tree)

salmonella, campylobacter, shigella, yersinia

112
Q

complications of yersinia infection

A

yersiniosis

autoimmune type thyroiditis
pericarditis
glomerulonephritis

113
Q

what organisms can lead to HUS? prognosis?

A

EHEC (O157:H7)
shigella

high mortality rate, with microangiopathic hemolytic anemia, thrombocytopenia, renal insufficiency

114
Q

differentiate between the sx of a small bowel infection and a colon infection

A

small bowel= watery stool, dehydration/malabsorp, weight loss, NO WBCs in stool, pain either diffuse or in midabd

large bowel= frequent small volume stools, blood or WBCs in stool, lower abd/rectal pain

115
Q

organism with high infection in IgA deficiency

A

giardia

116
Q

people with hemochromatosis are at higher risk for infection by

A

vibrio species
listeria
yersinia

117
Q

AIDS pts are more susceptible to…

A

mycobacteria
CMV, adenovirus, herpes
cryptosporidium, C. belli, microsporida, B. hominis,
N. gonnorrhea, T. pallidum, chlamydia

118
Q

once salmonella typhi infects the ___, you become a carrier

A

GB

119
Q

infants with watery or bloody diarrhea are likely to have

which histologically looks like

A

EPEC

loss of villi= ephacement

120
Q

non-bloody persistent diarrhea without a fever

more severe in immunocompromised

A

EAEC

121
Q

young kids in developing countries with fever, pain, dysentery

A

EIEC

122
Q

sx of C. dif

A

dehydration
hypoalbuminia
fever
waterry, smelly diarrhea

123
Q

hangs out on heart valves –> heart murmur

steatorrheacommon in white farmers

A

whipple ds

124
Q

the rotavirus vaccine is linked to ____, and is contraindicated in _____ patients bc it is a live vaccine

A

intussusception

immunocompromised

125
Q

most common cause of viral conjunctivitis in kids

A

adenovirus

126
Q

sx of e histolytica

A 
abd pain
bloody diarrhea
weight loss
necrotizing colitis
megacolon

GI2 E1 (19 decks)

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