Bacterial Diarrhea

Question 1

Acute Gastroenteritis:
Presentation
Etiology
Management

Answer 1

Presentation: Sudden onset, short duration, diarrhea and vomiting

Etiology: Organisms that make preformed toxins
S. aureus – enterotoxin
C. perfringens – heat labile enterotoxin
bacillus cereus

(also viruses)

Management: usually self limiting; oral rehaydraton (my require IV); antimotility and antiemetics for symptomatic relief

Question 2

Acute Watery Diarrhea:

• Presentation
• Etiology
• management

Answer 2

No (or mild) Fever
Diarrhea
Some cramps/vomiting
Mucosa/blood absent from stool

Etiology: 
Virus and parasites 
V cholera, 
things that cause inflammatory diarrhea but don't make it that far: 
Campy, Salmy, Shigella, EIEC

Treatment: Oral rehydration solution (electrolytes and GLUCOSE)

Question 3

Acute Inflammatory Diarrhea

• Presentation
• what is the subset with blood/mucous called?
• etiology

Answer 3

Presentation: cramps, abdominal pain + FEVER

Stool: mucous, blood
Dysentery: scant low volume bowel movements; blood and mucous; tenesmus

Etiologies; C diff,
Campy, Salmy, Shigella, EHEC, EIEC, Yersinia

Question 4

• what is a key diagnostic test to differentiate between acute watery diarrhea from acute inflammatory diarrhea ?

Answer 4

• Fecal Luekocytes

Question 5

What is the cornerstone treatment for all bacterial diarrhea infections ?

Answer 5

rehydration

Question 6

Who do you treat?

Answer 6

Confirmed shigella

Confirmed C diff

Suspected V cholera

Early campylopabacter

Question 7

Who do you not treat?

Answer 7

Non typohid salmonella in immunocompetent host (may prolong carrier state; symptomatic relapse)

Suspected EHEC – increased risk of HUS

Campylobacter > 3 days

Question 8

how do you treat Shigella:

Answer 8

Azithro
Cirpo
TMP/SMX
Ceftriaxone

Question 9

How do you treat C. diff

Answer 9

Metronidazole

Oral Vanc

Consider Fidoxomicin

Question 10

How do you treat cholera

Answer 10

Doxycycline
azithro

can shorten duration