AID 2 Flashcards
SIGNS OF DEHYDRATION
- thirst,
- dry mouth,
- decreased axillary sweat,
- decreased urine output,
- slight weight loss
Mild dehydration
SIGNS OF DEHYDRATION
- orthostatic fall in blood pressure,
- skin tenting,
- sunken eyes (or, in infants, a sunken fontanelle).
Moderate dehydration
SIGNS OF DEHYDRATION: Severe dehydration
- lethargy,
- obtundation,
- feeble pulse,
- hypotension,
- frank shock.
- is the most common travel-related infectious illness.
- time of onset is usually 3 days to 2 weeks
- generally self-limited, lasting |-5 days.
TRAVELER’S DIARRHEA
The most common isolates from persons with the classic
secretory traveler’s diarrhea syndrome.
Enterotoxigenic and Enteroaggregative strains of E. coli
are important settings for outbreaks of enteric infections
- Day-care centers,
- schools
- residential facilities,
- cruise ships
the most common etiologic agent associated with outbreaks of acute gastroenteritis.
Norovirus
has been identified as a cause of antibiotic-associated
hemorrhagic colitis.
Klebsiella oxytoca
Has been associated with outbreaks of diarrhea in nurseries
for newborns
Enteropathogenic E. coli
Causes significant diarrheal illness in elderly patients in
chronic care institutions. The use of Antibacterials alters the
normal colonic flora allowing multiplication of this bacteria.
C. difficile
most morbidity and mortality from enteric pathogens involves children
<5 years of age
high risk of invasive enteropathies, including salmonellosis, listeriosis, and cryptosporidiosis.
Defects in cell-mediated immunity (AIDS)
particular risk of C. difficile colitis and giardiasis.
Hypogammaglobulinemia
are more likely to develop C. difficile infection as a result of chemotherapy and frequent hospitalizations.
Patients with cancer
- stool examination indicate a noninflammatory etiology
- evidence of a common-source outbreak
- ingestion of specific foods
- the time of onset of diarrhea after a meal
BACTERIAL FOOD POISONING
Bacterial Food Poisoning: Sources of Food
1-6 hrs
- Staphylococcus aureus
- Bacillus cereus
- Ham,
- poultry,
- potato or egg salad,
- mayonnaise,
- cream pastries
- Fried rice
Bacterial Food Poisoning: Sources of Food
8-16hr (vomiting rare)
- Clostridium perfringens
- B. cereus
- Beef,
- poultry,
- legumes,
- gravies
- Meats,
- vegetables,
- dried beans,
- cereals
can produce either a syndrome with a short incubation period, mediated by a staphylococcal type of enterotoxin.
B. cereus the emetic form
longer incubation period (8—I6 h), caused by an
enterotoxin resembling F. cofi LT, in which diarrhea and abdominal cramps are characteristic but vomiting is uncommon.
B. cereus the diarrheal form
- longer incubation period (8—14 h)
- inadequately cooked meat, poultry, or legumes
- moderately severe abdominal cramps and diarrhea; vomiting is rare, as is fever.
Clostridium perfringens
NONBACTERIAL AGENTS OF FOOD POISONING
- Capsaicin is found in hot peppers
- Variety of toxins found in fish and shellfish
LABORATORY EVALUATION
Stool culture on selective media such as thiosulfate—citrate—bile salts-sucrose (TCBS) or tellurite-taurocholate—gelatin (TTG) agar:
CHOLERA
LABORATORY EVALUATION
Latex agglutination test
ROTAVIRUS
LABORATORY EVALUATION
RT-PCR and specific antigen enzyme immunoassays
NOROVIRUS
LABORATORY EVALUATION
Immunofluorescence-based rapid assays or standard microscopy
GIARDIA CYSTS OR CRYPTOSPORIDIUM
All patients with fever and evidence of inflammatory
Disease should test for
- SALMONELLA,
- SHIGELLA, AND
- CAMPYLOBACTER
Culture on MacConkey agar or in selenite enrichment broth:
SALMONELLA AND SHIGELLA
Rapid enzyme immunoassays, latex agglutination tests, or PCR
C. DIFFICILE
TREATMENT FOR DEHYDRATION
- REHYDRATION
- oral rehydration solution (ORS)
- “reduced-osmolarity/reduced-salt” (WHO recommended)
Secretory forms of traveler’s diarrhea is treated
- rehydration,
- bismuth subsalicylate,
- antiperistaltic agents
- Antimicrobial agents can shorten the duration of illness from 3—4 days to 24-36 h but may be associated with the acquisition of multidrug-resistant organisms.
TX of Bloody diarrhea and fever
- fluoroquinolone or a macrolide
- Individuals with shigellosis should receive a 3- to 7-day course.
TX of Campylobacter infection
- more severe or prolonged often benefit from antimicrobial treatment.
- macrolide antibiotic such as erythromycin or azithromycin
TX of Salmonellosis
- antimicrobial agents are at high risk of complications such as infants, patients with
- prosthetic devices,
- patients over age 50,
- immunocompromised persons.
Avoided drugs for tx of Enterohemorrhagic E. coli
- Antimicrobial agents should not be administered (especially children).
- Improvements in hygiene
Travelers should eat only
- hot, freshly cooked food,
- avoiding raw vegetables, salads, and unpeeled fruit;
- drink only boiled or treated water and avoiding ice.
- inexpensive agent for the prophylaxis of traveler’s diarrhea
- Adverse reaction: darkening of tongue and tinnitus
Bismuth subsalicylate
may lessen the likelihood of traveler’s diarrhea by
~15%.
Probiotics
indicated for the prevention of traveler’s§ diarrhea in
immunosuppressed or have other underlying illnesses
Rifaximin
Prophylaxis Vaccines Used to treat diarrhea
- Rotavirus vaccine
- Vaccines against S. Typhi and V. cholerae
