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Gastrointestinal 2 > Bacterial Gastroenteritis > Flashcards

Bacterial Gastroenteritis Flashcards

1
Q

How is diarrhoea defined?

A

More than three liquidy stools per day.

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2
Q

What are the two types of diarrhoea?

A

Inflammatory and Non-inflammatory

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3
Q

What are the usual causes of inflammatory diarrhoea?

A

Invasive pathogens

Chronic inflammatory bowel disease

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4
Q

What are the two mechanisms of inflammatory diarrhoea?

A

Secretory

Osmotic

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5
Q

What are the common causes of acute diarrhoea?

A

Pathogens (viruses, bacteria, parasites, protozoa).

Non-infectious causes e.g stress, medications, toxic ingestion.

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6
Q

How is acute diarrhoea usually characterised?

A

Non-inflammatory
Secretory
Watery stools are associated with vomitting.

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7
Q

How does acute inflammatory diarrhoea differ from non-inflammatory?

A

Stools are bloody and mucousy
Severe abdominal pain
Fever

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8
Q

What causes acute inflammatory diarrhoea?

A 
Shigella
Salmonelle
Yirsinia
Campylobacter
E.coli

SSYCE

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9
Q

What is the treatment for acute diarrhoea?

A

Fluids - oral rehyrdration therapy
Dietary adjustments
Antibiotic treatment - for people severely ill or have risk factor complications or travel associated.

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10
Q

What are the 3 mechanisms by which bacteria can cause diarrhoea?

A
  1. Secretion of toxins e.g enterotoxins
  2. Production of cytotoxins by the bacteria
  3. Direct invasion - intracellular bugs cause diarrhoea through direct invasion.
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11
Q

What are the infectious agents associated with eating raw sea food?

A

Virbrio
Norovirus
Hepatitis A
Salmonella

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12
Q

Summarise the likely history of an infection involving campylobacter.

A
  1. Commonly associated with poultry - classic for it to be a BBQ.
  2. Incubation time of days.
  3. Vommitting unlikely.
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13
Q

What are the potential symptoms you would see in a infection due to campylobacter?

A

Guellian Barre Syndrome
Bloody diarrhoea
Abdominal pain

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14
Q

Guellian Barre Syndrome

A

Guillain–Barré syndrome (GBS) is a rapid-onset muscle weakness caused by the immune system damaging the peripheral nervous system. The initial symptoms are typically changes in sensation or pain along with muscle weakness, beginning in the feet and hands.

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15
Q

What pathophysiology causes the symptoms in campylobacter infection?

A

Production of cytotoxins.

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16
Q

What type of bacteria is campylobacter?

A

Gram negative bacilli

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17
Q

What is the incubation period for an infection with salmonella?

A

Hours to days

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18
Q

What symptoms may be seen in a salmonella infection?

A

Diarrhoea
Vomiting
Fever

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19
Q

What is a typical history of someone infected with salmonella?

A

Eating egg / fish

Travel history increases risk as food standards are more relaxed abroad.

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20
Q

What type of bacteria is salmonella?

A

Gram negative bacilli

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21
Q

What is the incubation period for an infection with shigella?

A

1 - 6 Days

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22
Q

What symptoms may be seen in a shigella infection?

A

Bloody diarrhoea / Dysentery

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23
Q

What is a typical history of someone infected with shigella?

A

Commonly associated with norovirus.

Very infectious - so many someone that is also ill.

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24
Q

What type of bacteria is shigella?

A

Gram negative bacilli

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25
Q

What is the pathophysiology of shigella?

- what is the significance of this?

A

Shigella produces cytotoxins, hence the bloody diarrhoea.

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26
Q

What is the incubation period for an infection with e.coli?

A

Hours to days

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27
Q

What symptoms may be seen in a e.coli infection?

A

Traveller’s diarrhoea (bloody).
Nausea
Vomiting
Fever

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28
Q

What is a typical history of someone infected with e.coli?

A

Petting zoo - associated with animal interaction.

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29
Q

What type of bacteria is e.coli?

A

Gram negative bacilli

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30
Q

What complications are there when someone has an e.coli infection?

A

Haemolytic-uraemic syndrome

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31
Q

Haemolytic-uraemic syndrome

A

Haemolytic-uraemic syndrome involves massive activation of clotting factors. However there is then none left so increased risk of bleeding as a result.

Kidney failure can also be observed due to damage to the small blood vessels of the kidney.
- clinically presents as high creatinine levels.

32
Q

What is the incubation period for an infection with bacillus cereus?

A

Hours - very short incubation time.

33
Q

What symptoms may be seen in a bacillus cereus infection?

A

Severe vomiting and abdominal pain.
Diarrhoea - enterotoxin
Vomiting - emetic toxin

34
Q

What is a typical history of someone infected with bacillus cereus?

A

Classically associated with eating rice a few hours before onset of symptoms.

35
Q

What type of bacteria is bacillus cereus?

A

Gram positive rod.

36
Q

Why should you avoid treating someone with e.coli infection with antibiotics?

A

Antibiotics may make diarrhoea worse and increase the risk of hemolytic-uremic syndrome.

37
Q

Enterotoxin

A

A toxin produced in or affecting the intestines, such as those causing food poisoning or cholera.

38
Q

Emetic toxin

A

The emetic type is caused by a heat-stable toxin, named cereulide, preformed in the food.
- created by bacillus cereus if rice is not stored in suitable conditions and then reheated.

Note: Re-heating kills the bacillus cereus bacteria but not the cereulide it produces.

39
Q

Describe Staph Aureus:

  • Incubation time
  • Symptoms
  • History
  • Bacteria type
A

Incubation: Hours - short incubation time.
Symptoms: Abdominal pain and vomiting.
History: Associated with pre-prepared food.
Bacteria type: Gram positive cocci

40
Q

Describe Clostridium perfringens:

  • Incubation time
  • Symptoms
  • History
  • Bacteria type
A

Incubation: Hours
Symptoms: Abdominal pain and diarrhoea
History: Associated with animals + environment, associated with food that hasn’t been kept warm properly.
Bacteria type: Gram positive rod

41
Q

What complications can arise due to an infection with clostridium perfringens?

A

Gas gangrene

42
Q

Gas gangrene

A

A bacterial infection that produces tissue gas in gangrene. This deadly form of gangrene usually is caused by Clostridium perfringens bacteria.

43
Q

Describe Yersinia enterocolitica:

  • Incubation time
  • Symptoms
  • History
  • Bacteria type
A

Incubation: Days
Symptoms: Abdominal pain, diarrhoea, fever, mimics appendicitis in children.
History: Severe abdominal pain that mimics appendicitis
Bacteria type: Gram negative bacillus

44
Q

Describe Vibrio Cholerae:

  • Incubation time
  • Symptoms
  • History
  • Bacteria type
A

Incubation: Days
Symptoms: Rice water stools (little bits of mucin). Severe dehydration.
History: Profuse rice water diarrhoea - due to drinking contaminated water.
Bacteria type: Gram negative comma shaped bacterium

45
Q

Explain the pathogenesis of how vibrio cholerae causes diarrhoea.

A

Vibrio cholerae produces a secretory toxin that increases CAMP production.
CAMP inhibits absorption of Cl- and Na+ creating an osmotic pull of water into the large intestine.

46
Q

What is the treatment for vibrio cholerae?

A

Oral rehydration therapy

CFTR inhibitors - block Cl- secretion preventing diarrhoea.

47
Q

What causes typhoid fever?

A

A specific type of salmonella.

48
Q

Describe Listeria monocytogenes:

  • Incubation time
  • Symptoms
  • History
  • Bacteria type
A

Incubation: Days - months
Symptoms: Bacteraemia, Meningitis, Septic abortion. Systemic unwellness, meningeal encephalitis - fever.
Low GCS caused by inflammation of the brainstem.
History: Associated with dairy products.
Bacteria type: Gram positive rod

49
Q

Why is Listeria monocytogenes associated with diary products?

A

Listeria can replicate at low temperature e.g 4 degrees and therefore can replicate in the fridge.
- if milk / cheese isn’t pasteurised properly then the listeria can replicate.

50
Q

What are the complications associated with Listeria monocytogenes?

A

If pregnant, risk of abortion.
Bacteraemia can cause sepsis.
Risk of meningitis.

51
Q

What are the general treatments for someone with a bacterial infection?

A

Give fluid if dehydrated due to diarrhoea / vomiting.
Look for signs of sepsis.
Isolate patient to prevent spread in hospital.

52
Q

Abdominal guarding (tensing when examined) is a sign of what?

A

Peritonitis

53
Q

Case Study - what’s the bacteria causing the infection?

A 45 year-old businesswoman presents with
vomiting, diarrhoea and fever. She returned
from southern Spain 24 hours ago. Her last meal
before flying home was an egg salad sandwich in
the airport.

A

Salmonella

- egg, abroad, hours - days incubation

54
Q

Case Study - what’s the bacteria causing the infection?

A 31 year-old nursery assistant presents with a
2-day history of bloody diarrhoea. He reports
that several children have been kept home from
the nursery because of diarrhoea in the last
week.

A

Shigella

- associated with norovirus as very infectious + blood diarrhoea.

55
Q

Case Study - what’s the bacteria causing the infection?

A 6 year-old girl presents with fever, nosebleeds
and severe hypotension. Her platelet count is
16, prothrombin time is prolonged and
creatinine is 440. 1 week ago she had an episode
of diarrhoea and vomiting following a visit to a
petting zoo.

A

E.coli

- Animals, Haemolytic-uraemic syndrome indicated by nosebleeds, hypotension and kidney dysfunction.

56
Q

Case Study - what’s the bacteria causing the infection?

A 19 year-old man presents with severe
vomiting and abdominal pain 4 hours after
eating egg fried rice from a local takeaway.

A

Bacillus Cereus

- reheated rice causing vomiting and abdominal pain. Short 4 hour incubation time.

57
Q

Case Study - what’s the bacteria causing the infection?

A 24 year-old SHO presents with vomiting 45
minutes after eating pre-prepared sandwiches
at a conference. The illness resolves within 24
hours.

A

Staph Aureus

- Very short incubation time + pre-prepared food.

58
Q

Case Study - what’s the bacteria causing the infection?

A 45 year-old nurse presents with abdominal
pain and diarrhoea 24 hours after eating at a
local world cuisine buffet.

A

Clostridium perfringens

- buffet due to food not being kept warm enough.

59
Q

Case Study - what’s the bacteria causing the infection?

A 24 year-old woman presents with severe
abdominal pain and diarrhoea. She undergoes a
laparotomy and her appendix is removed, which
is normal.

A

Yersinia enterocolitica

- Severe abdominal pain that mimics appendicitis.

60
Q

Case Study - what’s the bacteria causing the infection?

A 31 year-old healthcare worker returns from a
Medecins-Sans-Frontiers trip to Haiti providing
hurricane relief. She has severe mucoid
diarrhoea and is visibly dehydrated and
hypotensive.

A

Vibrio cholerae

- drinking contaminated water, rice watery stools, dehydration, abroad.

61
Q

Case Study - what’s the bacteria causing the infection?

A 29 year-old pregnant woman presents with
diarrhoea, fever and confusion after returning
from a recent trip to the south of France.

A

Listeria monocytogenes

- Confusion, systemic fever, France - linking to dairy consumption.

62
Q

Why is clostridium perfringens known as “The Cafeteria Germ”?

A

It typically infects food made in large quantities and those kept warm for long periods - such as in cafeteria’s and buffets.

63
Q

Clostridium difficile most commonly affects what population?

A

Those whom have just taken antibiotics.

64
Q

Campylobacter jejuni affects where in the gastrointestinal system?

A

Jejuni = jejenum

65
Q

How is campylobacter jejuni usually transmitted?

A

From animals to humans via the faecal oral route.

Present in poultry + unpasteurised milk.

66
Q

What are the complications that can occur with a campylobacter jejuni infection?

A

Bacteraemia
Guellian Barre syndrome
Reactive arthritis - caused by autoimmune inflammatory condition where the immune cells attack the joints.
Toxic megacolon

67
Q

What are the symptoms of toxic megacolon?

A

Bloating
Tachycardia
Loss of bowel sounds

68
Q

Explain the pathogenesis of enterotoxins vs cytotoxins.

A

Enterotoxin - Fluid secretion without damaging the intestinal mucosa - causes watery diarrhoea.

Cytotoxin - Damage to mucosa, causes dysentery.

69
Q

Dysentery

A

Dysentery is an intestinal inflammation, primarily of the colon. It can lead to mild or severe stomach cramps and severe diarrhoea with mucus or blood in the faeces.

70
Q

Read this on mucosal invasion by bacteria:

A

Mucosal invasion by bacteria: Invasive pathogens, such as Shigella, enteroinvasive E. coli and Campylobacter, penetrate into the intestinal mucosa. Subsequent destruction of the epithelial cells allows further bacterial entry, which also causes the typical symptoms of dysentery: low-volume bloody diarrhoea, with abdominal pain.

71
Q

Summarise clostridium difficile:

  • symptoms
  • gram stain
A

Clostridium difficile causes watery diarrhoea, colitis and pseudomembranous colitis. It is a Gram-positive, anaerobic bacillus.

72
Q

Explain the pathogenesis of clostridium difficile.

A

Pathogenesis. C. difficile produces two toxins: toxin A is an enterotoxin while toxin B is cytotoxic and causes bloody diarrhoea. It causes illness either in patients who have been given antibiotic therapy that has eliminated other bowel commensals, or in those who are debilitated for other reasons.

73
Q

Haemolytic uraemic syndrome is characterised by what two features?

A

The destruction and breakdown of red blood cells and the declining function of the kidney resulting in uraemia.

74
Q

What is the main cause of HUS?

A

Tiny blood clots in small vessels, predominantly in the kidney.

75
Q

What is HUS classically triggered by (especially in children)?

A

Triggered by a bout of bloody diarrhoea - termed diarrhoea positive HUS.

76
Q

Which bacterium are linked to causing HUS?

A

E.coli and Shigella

Gastrointestinal 2 (24 decks)

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