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GI 2 > Acute Infectious Diarrhea > Flashcards

Acute Infectious Diarrhea Flashcards

1
Q

In the US, what are five groups that are high risk for infectious diarrhea?

A
  • travelers
  • immunodeficient
  • daycare employees, kids, and their family
  • institutionalized
  • consumers of certain foods
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2
Q

List some risk factors for acquiring infectious diarrhea.

A
  • recent abx
  • ill contacts
  • exposure to unclean water
  • animal exposure
  • consuming raw/undercooked meat
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3
Q

What effects of dehydration would you see on temperature, blood pressure, and heart rate?

A

-fever, hypotension, and tachycardia

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4
Q

What are signs of mild, moderate, and severe diarrhea?

A

mild- thirst, decreased sweat and urine,

moderate - orthostatic fall in BP, tenting, sunken eyes

severe - lethargy, weak pulse, frank shock

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5
Q

What would you expect to hear when auscultating bowel sounds in a patient with diarrhea? In a patient with ileus or toxic megacolon?

A
  • increased bowel sounds in diarrhea

- decreased/absent sounds in ileus or toxic megacolon

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6
Q

True or False: route of transmission for acute infectious diarrhea is typically fecal-oral

A

True

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7
Q

True or False: most cases of acute infectious diarrhea are mild and self-limited.

A

True

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8
Q

What are red flag indications of acute infectious diarrhea that would indicate that a work-up is necessary?

A
  • 6+ diarrhea stools/day with dehydration
  • mucoid, bloody diarrhea
  • fever greater than 101F
  • lasts 48+ hrs w/o improvement
  • new community outbreaks
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9
Q

What blood work would you order for acute infectious diarrhea?

A
  • CBC
  • electrolytes
  • BUN
  • Cr
  • Blood culture
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10
Q

What stool studies would you order for acute infectious diarrhea?

A
  • fecal leukocytes
  • fecal calprotein (checks for IBD)
  • fecal lactoferrin (checks for IBD or inflammatory cause)
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11
Q

What pathogens are normally included in a routine bacterial stool culture?

A
  • salmonella
  • shigella
  • E. coli
  • Campylobacter (maybe)
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12
Q

How long does it take for stool cultures to return?

A

24-48 hrs

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13
Q

What are other stool tests besides a bacterial culture?

A
  • stool immunoassay for C. diff PCR/toxin
  • O and P
  • stool protozoal Ag for parasites like giardia and crypto
  • stool viral PCR/Ag for rotavirus and norovirus
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14
Q

What test (other than radiology) would you order if the stool studies didn’t reveal anything?

A

-endoscopy, upper or lower

  • upper EGD w/ duodenal aspirates and biopsy
  • lower flexible sigmoidoscopy w/ biopsy
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15
Q

What kinds of radiology might you order if stool studies didn’t reveal anything?

A
  • plain abd xray
  • -detects free intraperitoneal air
  • -assess for ileus or toxic megacolon
  • abd CT usually w/ PO/IV contrast
  • -more sensitive for free air; identify colitis
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16
Q

What pathogens are normally associated with chicken?

A
  • salmonella
  • campylobacter
  • shigella
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17
Q

What pathogen is normally associated with undercooked hamburger?

A

-E. coli O157:H7 (EHEC)

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18
Q

What pathogen is normally associated with fried rice?

A

B. cereus

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19
Q

What pathogen is normally associated with potato salad, mayonnaise, or cream pastries?

A

S. aureus

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20
Q

What pathogen is normally associated with eggs?

A

-salmonella

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21
Q

What pathogen is normally associated with deli meats or soft cheeses?

A

-L. monocytogenes

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22
Q

What pathogens are normally associated with seafood?

A
  • vibrio
  • salmonella
  • Hep A
  • norovirus
  • campylobacter
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23
Q

What are the symptoms of Staphylococcus aureus (a gram-positive cocci, clustered like grapes)?

A
  • N/V
  • watery diarrhea
  • rapid onset (within 6h due to preformed enterotoxin)
  • rapid resolution (within 24-48h)
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24
Q

What are the symptoms of Bacillus cereus (a gram-positive rod)?

A
  • vomiting (main symptom)
  • watery diarrhea
  • rapid onset (within 6h due to preformed enteroxin)
  • rapid resolution (within 24-48h)
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25
Q

What are the symptoms of C. perfringens (a gram-positive, heat-resistant, spore-forming rod)?

A
  • watery diarrhea w/abd cramping and pain
  • NO fever, NO vomiting
  • rapid onset (within 8-16h d/t preformed enterotoxin)
  • rapid resolution (within 24-48h)
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26
Q

True or False: you need to consume large quantities of Clostridium perfringens to develop symptoms

A

True

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27
Q

What are the symptoms of Shigella (gram-negative rods)?

A
  • fever for 3-4 days
  • symptoms last 1-2 weeks
  • bloody diarrhea (it’s the classic cause of dysentery)
  • -begins watery, then progresses to blood and pus
  • -small volume w/ cramping and intense colitis
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28
Q

What GI condition would also be in the differential for Shigella?

A

IBD

-need fecal leukocytes and culture to differentiate

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29
Q

What is a possible complication of Shigella, post-infection?

A
  • reactive arthritis and HUS
  • -conjunctivitis, urethritis, arthritis
  • HLA-B27 genotype is involved
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30
Q

What are the symptoms, lasting 5-10 days, of Salmonella typhimurium (gram-negative motile rod)?

A
  • watery to bloody diarrhea
  • fever
  • abd cramping
  • N/V
  • fecal leukocytes +
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31
Q

What group of immunocompromised individuals is at increased risk of S. typhimurium?

A

Sickle Cell pts

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32
Q

What are complications of S. typhimurium?

A

-septic arthritis, abscess, osteomyelitis

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33
Q

What are the symptoms of Salmonella typhi (gram-negative, anaerobic rod that causes typhoid fever)?

A
  • 2 symptomatic phases, separated by no symptoms
  • -sustained fever of 103-104F
  • -rose spots
  • -smelly, pea soup diarrhea, or bloody diarrhea
  • -relative bradycardia w/ dicrotic pulse
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34
Q

What are the diagnostic tests used for S. typhi?

A
  • stool cultures
  • blood cultures (90% when febrile)
  • fecal leukocytes
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35
Q

What is the mechanism behind how Salmonella organisms cause disease?

A
  • penetration of small intestine mucus layer

- then, the organisms transverse the epithelium through M cells that overlay Peyer’s Patches

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36
Q

What is unique about how S. typhi interacts with the body vs. S. typhimurium?

A

-S. typhi can have “healthy carriers” when the organisms colonize the gallbladder (ex: Typhoid Mary)

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37
Q

What are the symptoms of Campylobacter jejuni (gram-negative curved/spiral rod)?

A
  • watery to bloody diarrhea
  • fever
  • crampy abd pain
  • erythema nodosum
  • resolves in a week (maybe up to 3-4wks)
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38
Q

How do you diagnose C. jejuni?

A
  • fecal leukocytes

- stool culture on Campy Blood Agar

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39
Q

What is a complication of C. jejuni?

A
  • Guillian Barre Syndrome 1-8wks after diarrhea

- -ascending symmetrical muscle weakness/paralysis

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40
Q

What are the symptoms of Vibrio cholerae (gram-negative, comma-shaped anaerobic rod w/ flagellum)?

A
  • N/V
  • abd cramping
  • profuse rice water diarrhea (1L/hr)
  • dehydration d/t electrolyte imbalance
  • -hypotension leads to renal failure and eventual death
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41
Q

What are the diagnostic tests for V. cholerae?

A
  • stool microscopy to identify motile, darting rods

- gram stain of stool specimen

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42
Q

What are the treatment and prevention of cholera?

A
  • rehydration and electrolyte replacement
  • abx may shorten duration
  • sanitation and vaccination to prevent
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43
Q

What are the symptoms of V. parahemolyticus (gram-negative cytotoxin-producing rod)?

A
  • N/V
  • abd cramps
  • watery to bloody diarrhea
  • resolves in 2-5 days
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44
Q

What are the symptoms of V. vulnificus (gram-negative rod)?

A
  • -vomiting and diarrhea within 16 hrs
  • -bullous skin lesions in open wounds
  • -cirrhosis in pts w/ hemochromatosis
  • -life-threatening for immunocompromised
  • -coastal saltwater is a risk
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45
Q

What are the symptoms of Aeromonas hydrophila (gram-negative spore-forming facultative anaerobic rod?

A
  • One type: watery rice stool diarrhea
  • Second type: bloody mucoid stool

-rapidly progressing wound infection after freshwater exposure (necrotizing fasciitis)

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46
Q

What are the risk factors of Aeromonas hydrophila?

A
  • freshwater or brackish water

- foot and ankle wounds in the water

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47
Q

What is the most common pathogen for Traveler’s Diarrhea?

A

-enterotoxigenic E. coli (ETEC)

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48
Q

What are the symptoms of ETEC (gram-negative rod)?

A
  • N/V
  • watery diarrhea
  • occasional fever
  • sudden onset
  • resolves in 3-6 days
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49
Q

True or False: ETEC must be diagnosed clinically

A

True; stool cultures cannot differentiate between ETEC and other E. coli strains found in normal colonic microbiota; additionally fecal leukocytes are negative

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50
Q

What are the symptoms of E. coli O157:H7 (EHEC - a gram negative rod that produces shiga-like toxin)?

A
  • watery to bloody diarrhea
  • abd tenderness
  • NO fever
  • most common cause of acute hemorrhagic colitis
  • most common cause of ARF in children
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51
Q

How is E. coli O157:H7 diagnosed?

A
  • CBC peripheral leukocytes, anemia, thrombocytopenia
  • fecal leukocytes +
  • fecal lactoferrin +

–stool culture shows shiga-like toxin

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52
Q

What is the treatment of E. coli O157:H7?

A
  • supportive
  • rehydration

-abx use increases risk of HUS, so abx are only used in severe cases

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53
Q

What are complications of E. coli O157:H7?

A
  • hemolytic uremic syndrome
  • -5-10 days into illness
  • -much more likely in children
  • -more likely if treated w/ abx
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54
Q

What are other forms of E. coli and their characteristics?

A
  • Enteroaggressive E. coli (EAEC)
  • -persistent diarrhea in kids, non-bloody, afebrile
  • Enteropathogenic E. coli (EPEC)
  • -infantile watery/bloody diarrhea
  • Enteroinvasive E. coli (EIEC)
  • -fever, abd pain, water/bloody diarrhea w/leukocytes (dysentery)
55
Q

What are the symptoms, lasting 10-20 days, of Yersinia enterocolitica (gram-negative coccobacilli)?

A
  • diarrhea (may be bloody)
  • fever
  • N/V
  • abd pain on R side + pharyngitis
  • -d/t infection in the terminal ileum
56
Q

-What other diseases are on the differential for Y. enterocolitica?

A
  • appendicitis
  • Crohn’s
  • Salmonella, Shigella (clinically indistinguishable)
57
Q

How is Y. enterocolitica diagnosed?

A
  • blood or stool cultures (special media needed)

- fecal leukocytes +

58
Q

Derangement of what element’s metabolism enhances the virulence of Y. enterocolitica?

A

–Iron: pts with iron-overload syndromes, cirrhosis, hemochromatosis, aplastic anemia, and thalassemia

–also increases in pts with diabetes and pre-existing GI disorders

59
Q

What are complications of Y. enterocolitica?

A
  • erythema nodosum (like Campylobacter)
  • reactive arthritis (like Shigella)
  • myocarditis
  • kidney disease
60
Q

What are the symptoms, lasting 2-3 days, of Listeria monocytogenes (gram-positive rod)?

A
  • -non-bloody diarrhea
  • -fever
  • -headache
  • -N/V
  • -during pregnancy: mild fever and malaise
61
Q

How is L. monocytogenes diagnosed?

A
  • blood culture
  • CSF
  • cannot be cultured from stool samples
62
Q

Who is at risk for L. monocytogenes?

A
  • pregnant women
  • age extremes
  • immunosuppressed
  • pts with hemochromatosis
63
Q

What are complications of L. monocytogenes?

A
  • meningoencephalitis

- Listeria placentitis

64
Q

What are the symptoms of Tropheryma whipplei (gram-positive rod)?

A
  • -low-grade intermittent fever
  • -arthralgias
  • -weight loss
  • -malabsorption
  • -chronic diarrhea
65
Q

How is Tropheryma whipplei treated?

A

-abx results in dramatic improvement within several weeks, but prolonged Tx for at least a yr is required

  • prefer to use drugs that cross the BBB
  • duodenal biopsies needed q6 months for 1yr
66
Q

True or False: Whipple Disease is fatal if left untreated.

A

True; some neurological signs (dementia, lethargy, coma, seizures, nystagmus) may be permanent.

Pts must be followed closely after Tx for signs of recurrence.

67
Q

What are the symptoms of C. diff (gram-positive, spore-forming, anaerobic, cytotoxin-producing rod)?

A
  • watery diarrhea
  • abd pain
  • fever
68
Q

How is C. diff diagnosed?

A
  • stool assay PCR for toxin (A and B)
  • peripheral leukocytes +
  • pseudomembranes on colonic mucosa
69
Q

What are risk factors for C. diff?

A
  • hospitalization within the past 2 months
  • use of PPI

-abx use (esp. clindamycin, cephalosporins, and fluoroquinolones)

70
Q

What are prevention and treatments for C. diff?

A
  • wash hands with soap and water
  • PO/IV metronidazole
  • PO vanc
71
Q

What is a complication of C. diff?

A

-toxic megacolon; needs aggressive Tx and surgery consult for a colectomy (50% mortality rate)

72
Q

What is the most common cause of acute diarrhea in children under age 2?

A
  • -rotavirus
  • -more common in winter
  • -fecal-oral spread
73
Q

What type of virus is Rotavirus?

A

–double-stranded RNA (Reoviridae family)

74
Q

What are symptoms of Rotavirus?

A
  • vomiting
  • watery diarrhea
  • resolves after 2-5 days
  • may result in death d/t dehydration
75
Q

How is Rotavirus diagnosed?

A
  • -detected by viral culture or PCR

- -has a “wagon-wheel appearance” on EM

76
Q

What type of virus is Adenovirus?

A

–double-stranded DNA virus

77
Q

What are the symptoms of Adenovirus?

A
  • -fever of 103-104F and chills
  • -myalgias
  • -pharyngitis
  • -watery diarrhea
  • -vomiting
78
Q

What is the most common cause of viral conjunctivitis in children?

A

Adenovirus

79
Q

What type of virus is Norovirus?

A

–small, non-enveloped RNA virus

80
Q

What are the symptoms of Norovirus?

A
  • vomiting
  • watery diarrhea (4-8 stools per day)
  • resolves in 3 days
81
Q

True or False: work-up is necessary in Norovirus cases

A

False; the resolution of symptoms is so fast, no work-up is needed

82
Q

CMV rarely causes diarrhea except in what group of patients?

A
  • primarily in AIDS patients and organ transplant patients with a CD4 count < 200
  • or as a result of reactivation of a previous infection
83
Q

What type of virus is CMV?

A

–double-stranded DNA (Herpesviridae)

84
Q

What are symptoms of CMV (can last for several weeks)?

A
  • fever
  • abd pain
  • bloody diarrhea
85
Q

How is CMV diagnosed?

A

–endoscopy w/ biopsy of ulcerated lesions using CMV-specific stains

86
Q

What is the most common cause of dysentery in the world?

A

E. histolytica

87
Q

True or False: asymptomatic carriers of E. histolytica still need treatment

A

True

88
Q

What are the symptoms of E. histolytica (can persist from a few days up to a few weeks)?

A
  • fever
  • abd pain and tenesmus
  • bloody diarrhea
  • liver abscesses
  • -can penetrate bowel and enter portal circulation
89
Q

How is E. histolytica diagnosed?

A
  • -flask-shaped ulcer on histology
  • -stool for Ova and Parasite
  • -stool Ag (PCR for DNA)
  • fecal leukocytes +
90
Q

What are risk factors of E. histolytica?

A
  • endemic areas: Asia, Africa, Central/South America
  • crowded living conditions and poor sanitation
  • mental health institutions
  • ingestion of contaminated food/water
91
Q

What are complications of E. histolytica?

A
  • toxic megacolon

- pneumatosis coli (gas cysts in the bowel wall)

92
Q

What does giardia look like?

A

–pear-shaped protozoan w/ flagella and 2 nuclei

93
Q

What are the symptoms of Giardia, lasting 2-4 weeks?

A
  • watery, malodorous, persistent diarrhea
  • steatorrhea
  • belching/flatulence
  • abd pain and cramps
  • nausea, anorexia, and weight loss
94
Q

How is Giardia diagnosed?

A
  • stool Ag test

- Ova and Parasites checked 3x sequentially

95
Q

What are risk factors of Giardia?

A
  • -lakes, streams, hiking, camping
  • -beaver, cattle, dogs, rodents, bighorn sheep
  • -person-person transmission in daycares
  • -pts w/ IgA deficiency are more susceptible
  • -contaminated water in Russia
96
Q

What are the two different courses that Cryptosporidium can take for immunocompetent pts versus immunosuppressed pts?

A

–self-limited diarrhea (7-10 days) in immunocompetent pts

–life-threatening intractable diarrhea in immunosuppressed pts

97
Q

What are the symptoms of Crypto?

A
  • nausea
  • malaise
  • abd cramping
  • large volumes of watery diarrhea (20L/day)
98
Q

What are risk factors for Crypto?

A
  • contaminated food/water
  • swimming pools
  • daycare
  • unsanitary milk production
  • municipal water supply
99
Q

How is Crypto diagnosed?

A
  • -stool Ag detection
  • -direct microscopy
  • -modified acid-fast staining, direct fluorescent Ab
100
Q

What type of parasite is Strongyloides stercoralis?

A
  • nematode:roundworm
  • most common in tropics or subtropics
  • enters body through bare feet on contaminated soil
  • larva travel to lungs and grow
  • -they are coughed up and swallowed
101
Q

What are the symptoms of S. stercoralis?

A
  • mostly asymptomatic
  • -abd pain, bloating
  • -vomiting
  • -diarrhea
  • -cough, SOB
102
Q

What are risk factors for S. stercoralis?

A
  • -rural areas, associated w/ agriculture activities
  • -low socioeconomic status
  • -institutionalized populations
  • -hyperinfection in the immunocompromised
  • -HTLV-1 pts
103
Q

How is S. stercoralis diagnosed?

A
  • rhabditiform larvae in stool

- eosinophils in stool

104
Q

What are risk factors for Cyclospora cayetanensis?

A
  • produce from endemic areas (Guatemala, Haiti, Peru)

- -chlorine or iodine does NOT kill

105
Q

What are the symptoms of C. cayetanensis (lasts up to 21 days in immunocompetent, but can be indefinite in immunosuppressed) ?

A
  • watery diarrhea
  • malaise
  • anorexia
  • nausea
  • fever
106
Q

How is C. cayetanensis diagnosed?

A

detection of oocysts in stool sample

107
Q

What are the symptoms of Cytoisospora belli?

A
  • watery diarrhea
  • abd pain and cramping
  • malabsorption and weight loss
  • can be severe in immunosuppressed pts
108
Q

How is C. belli diagnosed?

A
  • eosinophilia
  • repeated stool samples and concentration procedures
  • -b/c oocysts are passed in small amts intermittently
  • duodenal specimens by biopsy
109
Q

By what laboratory methods can C. belli be visualized?

A
  • -wet mounts by microscopy w/ bright-field

- -stained by modified acid-fast

110
Q

What are characteristics of Ascaris lumbricoides?

A
  • -hookworm/whipworm
  • -soil-transmitted helminths
  • -fecal-oral transmission (ingest eggs from soil)
  • -can get long and cause BOWEL OBSTRUCTION
111
Q

What are characteristics of Diphyllobothrium latum?

A
  • fish tapeworm
  • can get up to 30ft long
  • abd symptoms
  • absorbs vit B12 and thus causes vit B12 deficiency
  • -pernicious anemia and neuro symptoms
112
Q

What are characteristics of Schistosoma mansoni?

A
  • trematode in Africa
  • 2nd common cause of African esophageal varices
  • -most common cause of small portal v. obstruction
  • contaminated freshwater snails
  • bloody stools, bladder CA, liver cysts
113
Q

What is the treatment for S. mansoni?

A

Praziquantel

114
Q

What are some characteristics of Taenia solium?

A
  • pork tapeworm (hooks)
  • mostly asymptomatic
  • -rare, serious cases of Cysticercosis (seizures) and muscle or eye disease
115
Q

What are some characteristics of Taenia saginata?

A
  • beef tapeworm (suckers)

- asymptomatic

116
Q

What are some characteristics of Echinococcus granulosus?

A
  • -tapeworm (DOGS are the main carriers)
  • -unsanitary SHEEP slaughter
  • -fecal-oral, poor sanitation
  • -FORM CYSTS IN LIVER OR LUNGS
  • -FREE-FLOWING “HYDATID SAND” on CT
117
Q

What are some characteristics of Enterobius vermicularis (Pinworm)?

A
  • -fecal-oral transmission
  • -severe perianal itching
  • -diagnosed by “Scotch Tape Test”
  • -Tx: Mebendazole
118
Q

When can anti-motility agents be used to treat acute infectious diarrhea?

A
  • when there’s no fever
  • when there’s no bloody stool

-do NOT use in C. diff or EHEC

119
Q

Name two causes of acute infectious diarrhea that are not phased by alcohol hand sanitizers.

A

C. diff

Noro

120
Q

Which causes of acute infectious diarrhea have vaccines?

A
  • Rotavirus
  • S. typhi
  • V. cholera
  • Hep A
121
Q

While bismuth subsalicylate may reduce the frequency of traveler’s diarrhea (and is safe for up to 3wks), it has side effects, such as:

A
  • darkening of the tongue and stools

- tinnitus

122
Q

True or False: antibiotic prophylaxis is recommended for traveler’s diarrhea

A

False; it is only indicated for use in immunocompromised, IBD, hemochromatosis, gastric achlorhydria

123
Q

Which causes of acute infectious diarrhea can be followed by reactive arthritis (Reiter’s Syndrome)?

A
  • Salmonella
  • Shigella
  • Campylobacter
  • Yersinia
124
Q

What are characteristics of reactive arthritis?

A
  • -conjunctivitis, urethritis, arthritis

- -HLA-B27

125
Q

What are some complications that can occur as a result of Yersiniosis?

A
  • -autoimmune-type thyroiditis
  • -pericarditis
  • -glomerulonephritis
126
Q

What are some characteristics of when pathogens affect the small bowel?

A
  • -large volume, WATERY stools
  • -abd cramps
  • -weight loss
  • -dehydration/malabsorption
  • -non-inflamatory
127
Q

What are some examples of pathogens that affect the small bowel?

A
  • S. aureus, B. cereus, C. perfringens
  • Crypto and Giardia
  • ETEC, EPEC
  • Y. enterolitica
  • Rotavirus, Norovirus, Adenovirus
128
Q

What are some characteristics of when pathogens affect the large bowel?

A
  • frequent, small volume BLOODY stools
  • FEVER
  • WBC in stool (inflammatory)
  • fecal leukocytes +
129
Q

What are some examples of pathogens that affect the large bowel?

A
  • Cambylobacter
  • Salmonella, Shigella
  • EIEC, EHEC
  • C. diff
  • E. histolytica
130
Q

Patients with lymphoma, HIV, or who have had bone marrow transplants are more susceptible to which causes of acute infectious diarrhea?

A
  • Cyclospora and Cytoisospora
  • Salmonella, Shigella
  • Campylobacter
  • CMV, Herpes, Adenovirus
  • Crypto
131
Q

Patients with IgA deficiency are more susceptible to what cause of acute infectious diarrhea?

A

Giardia

132
Q

Patients with hemachromatosis are more susceptible to what causes of acute infectious diarrhea?

A
  • Vibrio spp.
  • Listeria
  • Yersinia
133
Q

In AIDS pts, which agents (transmitted venereally per rectum) may contribute to proctocolitis?

A
  • N. gonorrhea
  • T. pallidum
  • Chlamydia

GI 2 (6 decks)

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