Acute Infectious Diarrhea Flashcards
What are the five high risk groups in the US for acute infectious diarrhea?
- Travelers
- Immunodeficient
- Daycare workers/attendees and their family
- Institutionalized persons (ex. nursing home)
- Consumers of certain foods
What is the pathogenesis of acute infectious diarrhea?
a. Bacterial toxins, enterotoxin producing bacteria
b. entero-adherent pathogens
c. cytotoxin producing and invasive microorganisms
- –> small bowel hypersecretion
- profuse, watery diarrhea
- marked vomiting
- minimal or no fever
- abruptly (within a few hours of ingestion)
- –> small bowel hypersecretion
- vomiting usually less
- abdominal cramping/bloating is greater
- fever is higher
- High fever, abdominal pain
What in the history would be a high risk factor for diarrhea?
- Recent antibiotics?
- Ill contacts?
- Travel?
- Risk factors like unclean drinking water?
- Daycare/Nursing home?
- Animal exposure?
- Immunosuppression/immunocompromised?
- Unpasteurized dairy?
- Consume raw/undercooked meat, fish, or shellfish?
- Pregnancy (listeriosis)?
Pt. presents with thirst, difficulty swallowing food due to a dry mouth, and has only urinated a few times in the past 24 hours. What is the classification of their diarrhea?
Mild
thirst, dry mouth, decreased, axillary sweat, decreased urine output, sligh weight loss
What signs would imply moderate dehydration? severe?
moderate - orthostatic fall in blood pressure, skin tenting, sunken eyes (infants = sunken fontanelle)
severe - lethargy, obtundation, feeble pulse, hypotension, frank shock
What do you typically hear on ausculation for diarrhea? ileus or toxic megacolon?
a. increased bowel sounds
b. decreased bowel sounds
What is the transmission of acute infectious diarrhea?
fecal-oral transmission
typically self-limited
Flow chart of acute diarrhea work up
38.5oC = 101.3oF
What is the standard workup for acute diarrhea?
nothing - typically it is self limited
What signs make you do a full evaluation of acute diarrhea?
- profuse diarrhea (6 or more stools/day) with dehydration
-
hypotension and tachycardia
- not responsive to initial volume repletion
- Dysentery? (bloody diarrhea with leukocytes [mucoid])
- fever ≥38.5°C
- duration >48 h without improvement
- recent antibiotic use (check for C. Diff)
- new community outbreaks
- associated severe abdominal pain
- in patients >50 years
- peritoneal signs
- elderly (≥70 years)
- immunocompromised patients
- creatinine level greater than 1.5 times the baseline value
- peripheral leukocytes ≥ 15,000 cell/uL
What tests might be included in the work up of acute diarrhea?
CBC
electrolytes
BUN
Cr
Blood culture
What is the key to diagnosis of acute diarrhea?
microbiologic analysis of the stool
What organisms are included in a routine stool culture?
- Salmonella
- Shigella (Shiga toxin)
- E. Coli
- Most detect campylobacter (although may need to be requested)
*Takes 24-48 hours for results
If you want to check for enterohemorrhagic or othertypes of E. coli, vibrio species, or yersinia, you have to do what?
ask the lab (not included on standard culture)
same goes for:
- stool immunoassay for C. diff
- Ova and parasites (need 3 samples)
- Stool protozoal antigen (giardia, cryptosporidium, E. histolytica)
- Stool viral PCR/antigen (rotovirus, norovirus)
If your stool studies are unrevealing, what’s the next step?
endoscopy:
flexible sigmoidoscopy with biopsies
upper endoscopy with duodenal aspirates and biosopies
What do you see here?
ileus or toxic megacolon
radiology can also detect free intraperitoneal air
What is a benefit of abdominal CT?
more sensitive for free air
identify colitis
If pt reports food poisoning from bad chicken, you might suspect:
salmonella, campylobacter, shigella
If pt reports food poisoning from undercooked hamburger, you might suspect:
enterohemorrhagic E. coli (O157:H7)
If pt reports food poisoning from fried rice, you might suspect:
bacillus cereus
If pt reports food poisoning from eggs, you might suspect:
salmonella
If pt reports food poisoning after eating a turkey sandwich with american cheese, you might suspect:
listeria
due to uncooked foods like lunch meat or soft cheeses
If pt reports food poisoning from seafood, you might suspect:
vibrio species, salmonella, acute hepatitis A, norwalk, campylobacter
- Staphylococcus Aureus*
a. microbiology
b. sx
c. tx
d. risk factors
- Bacillus cereus*
a. microbiology
b. sx
c. tx
d. risk factors
- Clostridum perfringens*
a. microbiology
b. sx
c. tx
d. risk factors
Shigella
a. microbiology
b. sx
c. dx/duration
d. tx
e. risk factors/complications
What are the four types of Shigella?
- Salmonella typhimurium*
a. microbiology
b. sx
c. dx/tx
d. risk factors
e. complications
- Salmonella typhi*
a. microbiology
b. sx
c. dx/tx
d. risk factors
- Campylobacter jejuni*
a. microbiology
b. sx
c. tx
d. risk factors
- Vibrio cholerae*
a. microbiology
b. sx
c. tx
d. risk factors
- Vibrio parahemolyticus*
a. microbiology
b. sx
c. tx
d. risk factors
- Vibrio vulnificus*
a. microbiology
b. sx
c. tx
d. risk factors
- Aeromonas hydrophila*
a. microbiology
b. sx
c. tx
d. risk factors
How soon after a trip does traveler’s diarrhea begin?
3 days to 2 weeks (most begin 3-5 days)
self limited - most resolve between 1-5 days
What medications are risk factors for traveler’s diarrhea?
H2 blockers, PPIs
What is the most common pathogen of traveler’s diarrhea?
ETEC - enterotoxigenic E. coli
affects small intestine
What organisms can cause TD?
Enterotoxigenic E. coli
Campylobacter jejuni
Salmonella
Shigella
Aeromonas
EAEC
Norovirus
Coronavirus
Giardia
Norovirus
Escherichia coli - enterotoxigenic: ETEC)
a. microbiology
b. sx
c. dx
d. tx
e. risk factors
Escherichia coli (enterohemorrhagic: EHEC)
a. microbiology
b. sx
c. dx
d. tx
e. risk factors
i feel like just use sketchy
bc this dsa is too much and if i tried to make flashcards in detail there would be 100000000
What sx do we see in the following?
a. Enteroaggregative E. coli
b. Enteropathogenic E. coli
c. Enteroinvasive E. coli
- Yersinia enterocolitica*
a. microbiology
b. sx
c. dx
d. tx
e. risk factors
- Listeria monocytogenes*
a. microbiology
b. sx
c. dx
d. tx
e. risk factors
What is the etiology of whipple disease?
Tropheryma whipplei
What do you see in hx/PE of someone with whipple disease?
arthralgias
weight loss
malabsorption
chronic diarrhea
HF
hypotension
What diagnositc tests are used to dx whipple disease?
How do we treat whipple disease?
antiobiotics
If untreated, whipple disease is…
fatal
goal of tx: prevent progression of neuro signs
- Clostridium difficile*
a. microbiology
b. sx
c. dx
d. tx
e. risk factors
For nosocomial infections, stool cultures are…
not helpful - except with c. dificile
- Rotavirus*
a. microbiology
b. sx
c. dx
d. tx
e. risk factors
- Adenovirus*
a. microbiology
b. sx
c. dx
d. tx
e. risk factors
Norwalk virus (norovirus)
a. microbiology
b. sx
c. dx
d. tx
e. risk factors
- Cytomegalovirus* (CMV)
a. microbiology
b. sx
c. dx
d. tx
e. risk factors
- Entamoeba histolytica*
a. microbiology
b. sx
c. dx
d. tx
e. risk factors
- Giardia lamblia*
a. microbiology
b. sx
c. dx
d. tx
e. risk factors
- Cryptosporidium parvum*
a. microbiology
b. sx
c. dx
d. tx
e. risk factors
- Strongyloides sterocoralis*
a. microbiology
b. sx
c. dx
d. tx
e. risk factors
- Cyclospora cayetanensis*
a. microbiology
b. sx
c. dx
d. tx
e. risk factors
- Cystoisospora belli*
a. microbiology
b. sx
c. dx
d. tx
e. risk factors
What is a concer with Ascaris lumbricoides?
can get long –> bowel obstruction
What parasite can get up to 30 feet long, cause B12 def, and comes from raw/undercooked fish?
Schistosoma mansoni
Taenia solium, Taenia saginata
Echinococcus granulosus
Enterobius vermicularis (pinworm)
In which patients can you use anti-motility agents?
those with no fever and non-bloody stools
*shouldn’t be used in c. diff or EHEC
What products can worsen diarrhea?
lactose containing products
Alcohol gels are ineffective against?
norovirus and c. diff
What infections have a vaccine?
rotavirus
s. typhi
v. cholera
hep a
What infections can cause reactive arthritis?
salmonella
campylobacter
shigella
yersinia
Yersiniosis can lead to…
AI type throiditis
pericarditis
glomerulonephritis
What causes guillian-barre syndrome?
campylobacter jejuni
What can cause hemolytic uremic syndrome?
Enterohemorrhagic E. coli
Shigella
Infections affecting ____ present with WBCs in the stool
large bowel
*can be blood too, fecal leukocytes are common
