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S4M2 > Aniket's Fried Rice > Flashcards

Aniket's Fried Rice Flashcards

1
Q

Factors that contribute to foodborne illness outbreaks in the US

A

“Boil, peel, cook, or forget it!”

  • Inadequate handling/refrigeration
    • cook too early
    • infected person with poor hygiene
    • Not cooked through
    • Not stored well
    • Not reheated
    • Raw ingredients contaminated
  • Heat food to 165F, store at 4F!
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2
Q

Treatment of foodborne illnesses

A
  • Self-limiting
  • Fluid & electrolyte replacement
  • Clostridium botulinum anti-toxin
  • Antibiotics:
    • salmonella, shigella, listeria, campylobacter, vibrio
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3
Q

Pathogenesis of invasive foodborne diseases

A

Inflammatory

  • Tissue invasion -> mucosa & neighboring cells destroyed
    • Cytotoxin -> destroy mucosal cells
  • Direct penetration thru distal small intestines -> bacteremia + dissemination

@ Distal small intestine, colon

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4
Q

Pathogenesis of toxin-mediated foodborne disease

A

Non-inflammatory

  1. Toxin mediated -> no tissue invasion;
    acts on secretory mechanism to change water flow
    1. In vitro: toxin in food made my vegetative cells. (premade)
    2. In vivo: vegetative cells in food are ingested. toxin made in gut
    3. Adherence

@ proximal small intestine

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5
Q

Toxin-mediated vs invasive:

  1. incubation period
  2. features
  3. illness
A

Toxin-mediated:

  1. Incu: in vitro 1-6h, in vivo 8-16h
  2. Feat: uppter GI -> N&V +/- diarrhea, NO fever/chill
  3. Diarrhea: watery

Invasive

  1. Inc: 16-48h
  2. Feat: Lower GI -> abd pain + diarrhea -> BLOODY +/- mucus/pus, fever and chills
  3. Diarrhea: Inflammatory +/- bood, Dystenteric + blood
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6
Q
  1. Inflammatory Diarrhea
  2. Dysentery
  3. Stool Smear of Toxin-mediated
  4. Stool Smear of Invasive
A
  1. Inflammatory => Inflammation of colon, distal small intestine, diarrhea +/- blood
  2. Dysentery => colonic inflammation w/small volume stools + blood/pus/mucus; tenesmus
  3. Toxin-med - NO fecal WBC
  4. Invasive - YES fecal WBC
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7
Q

Staph aureus food poisoning

  1. S/S
  2. Duration
  3. Entry into food
  4. Food sources
A

Incubation = 1- 6h (thus, in vitro)

  1. N&V, crampy abd pain, +/- diarrhea
  2. <24h resolution
  3. From hands of infected food preps
  4. Food: prepared food, not stored well
    • eggs, ham
    • dairy
    • chicken, tuna, mayo
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8
Q

Staph Aureus toxin

A

SEA

  • heat stable (withstands 100C for 30m)
  • refrigeration impedes growth

Superantigen– binds to neural receptors of Upper GI to induce vomiting in brain centers

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9
Q

Bacillus Cereus

Forms
S/S

A

Resolution <24h:

  • Short incubation -> Emetic
  • Long incubation -> Diarrheal
  • Chinese food :(
  • abdominal cramps, N&V
  • GI tract of Animal/human -> feces -> food
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10
Q

Bacillus cereus: Emetic Vs. Diarrheal

  1. Incubation
  2. Duration
  3. Toxin
  4. Path of Toxin
  5. Food Source
A

Emetic:

  1. Inc: 1-6h
  2. <24h
  3. In vitro heat stable (cereulide)
  4. Superantigen- binds 5HT receptor on vaguls -> ion channels in cell mem
  5. Fried rice

Diarrheal:

  1. Inc 8-16h
  2. <24h duration
  3. In vivo, heat labile
  4. Adenylate cyclase ↑cAMP -> ↑ fluid in Sm Int
  5. Meat
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11
Q

Clostridium perfringens

  1. Incubation
  2. S/S
  3. Food
  4. How it gets into you
A
  1. 6-24h inc
  2. Watery diarrhea +/- N&V
  3. Meat & Gravy
  4. GI tract of human/animal -> feces -> food
    • food prepared but vegetative cells are NOT KILLED
    • Outbreaks occur when food is prepped early and not refrigerated or cooled to room temp
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12
Q

Clostridium perfringens: toxin

A

In vivo toxin

Heat labile– function as superantigens

  • *Damage brush border of small intestine**
    • alter cell membrane permeability in ileum
  • —> lose fluid & intracellular protein
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13
Q

Clostridium botulinum:

  1. Incubation
  2. Toxin
  3. forms
A
  1. Incubation 18-36h
  2. In-vitro heat labile neurotoxin
    • inh ACh release @ NMJ to prevent contraction -> flaccid paralysis
  3. Forms:
    • Foodborne- most common in adults
    • Infant: floppy baby (raw honey!)- due to weak immunity
    • Inhalational: bioterrorism
    • Wound- spores in wound
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14
Q

Clostridium botulinum: S/S, Dx, Tx

A

5 Ds!

  1. Dysarthria
  2. Dysphagia
  3. Dysphonia
  4. Diplopia
  5. Descending paralysis
    • Symmetric UE wekness from Eye -> arm -> leg -> respiration
  6. +/- Diarrhea (infants have constipaton)

Dx: clinical impression– promptly treat!!!

Tx: Ventilation, Botulinum-specific antitoxin

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15
Q

Anti-Botulinum antitoxin

A

Botulinum-specific anti-toxin

arrests toxin circulating but DOESN’T improve damage already done– arrests progression of paralysis

Equine-derived heptavalent A-G for children >1yo & adults—- can cause serum sickness

Human-derived A&B (Baby B19)– children <1yo

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16
Q

Vibrio Cholera

  1. Characteristics
  2. S/S
  3. Incubation
  4. Serotypes
A
  1. Gram -, Ox +, comma-shaped
  2. INDIA, volumnous watery diarrhea (non-bloody), severe thirst
    • hTN, tachycardia, ↓ turgor, sunken eyes, ↑ bowel sounds, mucous flecks – Rice Water Diarrhea
  3. Incubation 16-72h
  4. >200 serotypes by LPS (O ag)
    • O1 = classic/el tor (worse)
    • O139
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17
Q

Vibrio cholerae

  1. Reservoir
  2. Locations
  3. Cases in US
  4. Who needs HIgh ID to be infected
  5. Who needs Low ID to be infected
A
  1. Human colon
  2. Haiti, S.Am, India, Africa via fecally-contaminated H2O
  3. US Gulft Coast– crabs & oysters
  4. Normal gastric acidity req high infx dose
  5. Achlorhydria, Hypochlorhydria, & PPI usage req lower ID
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18
Q

Vibrio cholerae: pathogenesis

A
  • Heat labile enterotoxin ↑ adenylyl cyclase -> ↑ watery diarrhea
  • Bacteriophage encodes gene tcp into bacterial cell– integrate into genome
  • tcp = toxin coregulated pilus– allows adherence
  • toxR controls toxin production in response to intestinal environment
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19
Q

Vibrio cholerae characteristics

A
  • abrupt onset of profuse, watery diarrhea & vomiting
    • rice water diarrhea
  • Can lead to hypovolemic shock within 4-12h of first liquid stool
    • 60% mortality untreated
20
Q

Vibrio cholerae: dx & tx

A

Dx:

  • TCBS (thiosulfate citrate bilesalt sucrose) agar
    • alkaline pH & NaCL required

Tx:

  • fluid & electrolyte replacement
  • antibiotic tx -> ↓ loss of fluid, ↓ exotoxin
  • Improve sanitation
21
Q

E. coli-related intestinal diseases:

  1. Toxin-mediated
  2. Invasive
A
  1. Toxin-mediated
    1. Enterotoxigenic e.coli (ETEC): MCC traveler’s diarrhea
    2. Enteropathogenic E.coli (EPEC): MCC neonatal nursery diarrhea
    3. Enteroaggregative E.coli (EAEC)
  2. Invasive
    1. Enterohemorrhagic (shiga-toxin producing) (EHEC)
    2. Enteroinvasive (EIEC)
22
Q

Enterotoxigenic E.coli (ETEC)

  1. S/S
  2. Incubation
  3. Duration
A
  1. Watery diarrhea (5-6/day)
    • cramping, flatulence
    • non-inflammatory (no WBCs)
    • +/- low-grade fever
  2. 24-48h incubation
  3. 3-4day resolution
23
Q

ETEC: Tx, pathogenesis

A
  1. Tx: ciprofloxacin, oral rehydration
    • +/- peptobismol (anti-motility)– use w/caution
  2. Toxins: both cause hypersecretion
    • Heat-stable toxin (ST) -> ↑ cGMP
    • Heat-labile toxin (LT) -> ↑cAMP
24
Q

Enteropathic E.coli (EPEC):

S/S

Pathogenesis

A

MCC Neonatal Nursery Outbreaks!

  1. <1yo, fever + watery diarrhea, NON-inflamm
  2. **NO TOXIN: **adhereance/superficial invasion mechanisms
    • Bundle-forming pili adhere to epithelial cell by forming attachment & effacement lesions -> disruption of normal microvilli -> malabsorption & watery diarrhea
25
Q

Enteroaggregative E.coli (EAEC)

  1. Affected population
  2. S/S
  3. Toxin
  4. IDing features
A
  1. Children <6yo, HIV pts
  2. Persistent diarrhea + low-grade fever
  3. Aggregative adherence fimbriae (autoagglutinate) & typical lesion– biofilm
  4. Inflamed microvilli tips -> hemorrhagic necrosis of tips -> short & round tips of villi -> malabsorption + watery diarrhea
26
Q

Invasive foodborne illnesses:

  1. Blood
  2. Blood rare
A
  1. BLOOD
    • EHEC
    • EIEC
    • Campylobacter
    • Shigella
  2. Blood RARE
    • C.diff
    • Salmonella typhi
    • Non-typhi Salmonella
    • Listeria
27
Q

Enterohemorrhagic/Shiga-toxin-producing E.Coli (EHEC)

  1. Demographics
  2. S/S
  3. Complications
  4. Tx
A
  1. Children <5yo, elderly:
    MCC acute renal failure in children
  2. 16-72h incubation–> abd cramping, watery diarrhea, blood in stool, ↓ urine vol
  3. Hemolytic uremic syndrome:
    Renal failure, thrombocytopenia, hemolytic anemia (↑BUN, createnine)
  4. Plasmaphoresis– NO ABX! (cause release of more toxin!!)
28
Q

EHEC (O157:H7)

  1. Source
  2. S/S
  3. Toxin
A
  1. Cattle
  2. Abd cramping, watery & bloody diarrhea W/O FEVER
  3. Efface microvilli -> actin polymerization
    - > form pedestal
    - > secrete intimin
    - > A/E lesions (attachment to surface of host cells)
    - > secrete shiga-like toxin (controlled by lysogenic phage)
    - > inh protein synth @ 60S ribosome
29
Q

EHEC (O157:H7)

lab dx

A

Sorbitol MacConkey agar– NON-sorbital fermenter so colonies will be CLEAR

30
Q

Enteroinvasive E.coli (EIEC)

A
  • Distal Small Intestine, Colon
  • Mucoid/bloody diarrhea
  • FECAL LEUKOCYTES
    • indicates DIRECT TISSUE INVASION
31
Q

Blood smear with Schistocytes & Burr cells?????

A

Renal problem due to Hemolytic Uremic Syndrome secondary to EHEC

32
Q

Clostridium dificile:

  1. S/S
  2. Toxin
A
  1. Antibiotic therapy kills normal flora
    • Frequent, loose, watery stools (bloody if severe)
    • Febrile, Abd tenderness
    • Pseudomembranous colitis
    • Tenesmus, perforation
  2. Toxins:
    • Toxin A: Enterotoxin that recruits neutrophils & moves into the ileum
      - > cytokine release, ↑ hypersecretion of fluid (diarrhea), necrosis
    • Toxin B: depolymerization of Actin -> cell death
33
Q

Clostridium dificile: lab dx

A
  • GOLD STANDARD* = Cytotoxin Assay (in vitro)
    • but takes forevaaa
  • *Toxin-enzyme immunoassay** for A&B or A
    • cheaper & RAPID, but ↓ sensitivity

Culture is of NO DIAGNOSTIC VALUE

34
Q

C. dificile: tx

A
  • Discontinue abx if possible & use metronidazole or vancomycin
  • Wash hands with SOAP & WATER (hand sanitizers don’t work on spores)
  • Contact isolation
35
Q

C. dificile :

  1. characteristics
  2. risk factors
A

MCC NOCOSOMIAL DIARRHEA

  1. Anaerobic, Gram+, Sproulating Bacillus
    Part of normal flora
  2. Risks = Ab exposure, hospitalization, PPI use
36
Q

Campylobacter jejuni

  1. Incubation
  2. S/S
  3. Complications
  4. Entry into food
A

Gram-, Ox+, curved rods

  1. 6-48h inc
  2. Fever, abd pain, diarrhea (>10/day)
    Fecal smear = leukocytes + RBCs
  3. Guillan-Barré
    Reactive Arthritis
    Hemolytic Uremic Syndrome
  4. GI of animals —- undercooked poultry, raw milk
37
Q

C.jejuni:

selection in lab

A

Campy/Skirrow’s agar

    • Blood/charcoal (remove O2)
    • abx (restrict normal flora)

42C
MICROaerophilic

38
Q

Shigella spp:

  1. Characteristics
  2. Types
A
  1. Ferment glucose, NOT lactose
    Colorless on MacConkey
  2. Types:
  • Sigella Sonnei: MCC of Shigellosis in US– mild diarrhea
    @ daycare, nurseries, prisons
  • Sigella flexneri: male homosexuals
  • Shigella dysenteriae 1: most severe form of shigellosis– @developing countries
39
Q

Which Shigellas cause dysentery?

A

S. flexneri

S. dysenteriae

40
Q

Shigella sonnei:

  1. Source, transmission, prevention
  2. Incubation
  3. S/S
  4. Pathogenesis
A
  1. ONLY IN HUMANS– hand-hand transmission (NOT fecal-oral!). Wash your damn hands.
  2. 1-3 day incubation, low ID
  3. Fever, abd pain, watery diarrhea, “straining” to pass stools, “fussy” (children)
  4. Invade intestinal cellls -> lamina propria
    Spread via cell-cell invasion
41
Q

Shiga Toxin

A

Disrupts protein synthesis @ 60S ribosome

  • > mucosal abscess forms as endothelial cells die
  • > “squirty stools”

lol

42
Q

Shigellosis

  1. Cause
  2. S/S
A
  1. S. sonnei, S. dysenteriae type 1
  2. ↓ LRQ abd pain, fever, bloody/mucousy stool, “squirty” stools, fecal WBCs

colonoscopy shows erythema, edema, friable ulcers

43
Q

Salmonella

Types
Characteristics

A
  1. Types:
    * Salmonella typhi* –> typhoid fever
    * Non-typhoid* –> gastroenteritis
  2. Colorless on MacConkey agar **don’t ferment lactose, but do glucose (like shigella)
  3. HE agar– produce H2S = black colonies
44
Q

Salmonella typhi

  1. Causes what?
  2. Reservoir & colonize
  3. Transmission
A
  1. Causes Typhoid Fever
  2. Humans– colonize gall bladder w/low ID
  3. Fecally contaminated food/H2O
45
Q

Salmonella typhi:

S/S

A

Gram- bacillus

  1. 1-3 weeks of:
    Fever, Non-specific sx (headach, weakness, anorexia, high fever, ROSE SPOTS)
    • Systemic dissemination & blood- > liver, spleen, BM –> rose spots (acute infx)
46
Q

Non-typhoidal Salmonella

  1. Reservoir
  2. Demographics
  3. FoodSources
  4. Incubation
  5. S/S
  6. Lab
A
  1. ALL animals (asymptomatic)
  2. Septicemia in young, geriatrics, or I/C pts
  3. Eggs
  4. 6-48h incubation
  5. 2d-1w of gastroenteritis– N/V, NON-bloody diarrhea
  6. Leukocytes in stool smear
47
Q

Tx of Non-Typhoidal Salmonella

A
  • Only use abx in non-septic pts who are I/C
  • 2 vaccines available
  • Treat septicemia w/abx determined by susceptibility testing

S4M2 (10 decks)

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