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GI Exam 1 > Bacterial Inf of GI Tract > Flashcards

Bacterial Inf of GI Tract Flashcards

1
Q

Improperly canned non-acidic food - what problem?

A

botulism - Clostridium

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2
Q

Botulism

  • when onset?
  • some effects on the body and its progression?
  • how is fever
A
  • 12 to 36 hours after eating improperly canned non-acidic food
  • dizziness, dry mouth, blurred or double vision - eye muscle weakness
  • abdominal pain, nausea, vomiting, and diarrhea or constipation
  • progressive paralysis: all voluntary muscles
  • no fever! == there is no bacterial infection!!
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3
Q

Most common cause of death with botulism?

A

-respiratory paralysis

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4
Q

Where is clostridium found?

A

endospores in the soil!

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5
Q

Clostridium

1) organism details:
2) where is it found in environment?
3) which toxins and which most common in humans
4) toxin production/activation?

A

1) Gram+; strict anaerobe; spore forming; rod
2) endospores found in soil - RESISTANT TO BOILING
3) A, B, C1, D, E, F, and G
4) toxin formed as inactive state and activated by proteolytic cleavage upon lysis

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6
Q

spores located at the end of the cells - organism is?

A

clostridium - botulinum

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7
Q

Botulinal toxin - type of toxin, what it does?

A
  • A-B bacterial toxin
  • B portion for binding to receptors on motor nerve endings
  • A-portion enters nerve cell and blocks discharge of acetylcholine = FLACCID PARALYSIS
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8
Q

Which organism causes a flaccid paralysis?

A

the botulinum toxin from clostridium causes this

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9
Q

Which organism causes a rigid paralysis?

A

Clostridium tetani TOXIN!

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10
Q

What does clostridium botulinum do to infants?

A
  • invades the intestines = constipation followed by generalized paralysis ==> FLOPPY BABY SYNDROME
  • Babies get this bc they lack full acidity of stomach and complete gut biome.
  • toxin and organism found in feces - low levels in blood
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11
Q

What organism causes floppy baby syndrome?

A

Clostridium botulinum TOXIN!!!!

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12
Q

Treatment of botulinum poisoning:

A
  • IV antitoxin - horse derived (15% get serum sickness)
  • neutralization of circulating toxin
  • takes weeks and months to regain full function
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13
Q

Clostridium difficile

  • organism details
  • causes what disease?
A

-gram pos, strict anaerobe, spore forming, rod-shaped

  • causes antibiotic associated pseudomembranous colitis
  • most common cause of nosocomial diarrhea
  • rarely invades GI epithelium
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14
Q

Clostridium difficile

  • found where in environment?
  • transmission?
A
  • found in GI tract of 3% of peoplel and tends to be found more often in hospital GI tracts
  • fecal oral transmission - usually hands of hospital personnel are intermediate
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15
Q

most common causes of clostridium difficile infection?

A

pseudomembraneous colitis - Antibiotic associated- most often caused by 2nd and 3rd gen cephalosporins

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16
Q

Most common cause of nosocomial diarrhea?

A

Clostridium difficile

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17
Q

**Two things needed to get clostridium difficile infection?

A
  • need to get the organism - in hospital or where ever

- need to disrupt the normal GI flora - aka with antibiotics; diet; stress; chemo

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18
Q

Appearance of pseudomembranes on colon mucosa?

A

white-yellow plaques

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19
Q

Stool finding - clostridium difficile?

A

non-bloody

neutrophils in half of patients

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20
Q

Clostridium difficile- patient presentation?

A
  • fever
  • abd cramping
  • toxic megacolon
  • toxin will be found in the stool
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21
Q

Clostridium difficile treatment?

A
  • antibiotic should be withdrawn
  • give metronidazole (prefered) or vancomycin (prevent creation of vanco resistant enterococci)
  • replace fluids

most often treatment does not get rid of carrier state =occurrence

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22
Q

Shigella -

1) causes what disease?
2) disease occurs where?

A

1) shigellosis

2) worldwide and especially where no sanitary practices

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23
Q

Shigella -
organism details?
-invades where?

A
  • gram neg; rod; non-lactose fermenting (colorless on MacConkey agar)
  • invades distal ileum and colon - rarely penetrate mucosa or enter blood stream
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24
Q

What organism confused with shigella? why?

A

Salmonella - also non-lactose fermenting

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25
Q

Distinguishing Shigella from Salmonella?

A

Shigella are different bc:

  • not motile
  • do not produce H2S
  • no gas production from glucose f ermentation
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26
Q

Shigella - virulence factors?

A

o-antigens (polysaccharide, LPS)

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27
Q

Infectious dose for Shigella vs salmonella?

A
  • shigella = LOW DOSE (EFFECTIVE GI PATHOGEN)

- salmonella = high dose

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28
Q

Shigellosis - presentation in patient?

A
  • 1-4 days incubation

- fever, cramps, wattery diarrhea that later contains blood and mucous

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29
Q

Most likely person to get Shigella or a dysentery infection?

A

someone who travels abroad

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30
Q

Shigella treatment:

A
  • fluid and electrolyes
  • no antibiotics for mild cases
  • if severe = give fluoroquinolone (ciproflaxin)
  • if peds patient=give Trimethoprim-sulfamethoxazole or azithromycin
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31
Q

Do not give what kind of drugs to shigellosis patient?

A

antiperistaltic drugs = prolongs fever, diarrhea and excretion of organism

32
Q

All fluoroquinolones increase risk for?

A

-tendinitis and tendon rupture

33
Q

Salmonella -

- causes what diseases?

A
  • enterocolitis
  • enteric fevers (typhoid)
  • septicemia with metastatic incfections such as osteomyelitis
34
Q

Salmonella- organism details?

A
  • gram neg rod
  • non lactosee fermenting
  • H2S production
35
Q

Salmonella- virulence factors:

A
  • Cell wall o antigen (LPS)

- flagellar H and capsular Vi

36
Q

All gram negatives have what virulence factor?

A

LPS! - o-antigen

37
Q

Salmonella typhimurium- causes what and invasion:

A

ENTEROCOLITIS-invades epithelial and subepithelial tissue of small and large intestines

  • penetrate lamina propria = inflammation & diarrhea - PMNs help prevent spread to adjacent LN but septicemia is possible
  • LARGE INFECTIVE DOSE NEEDED
38
Q

Important host defense against salmonella?

A

gastric acid!!!

39
Q

Salmonella Typhi- causes what and invasion?

A
  • typhoid - enteric fever
  • small intestine first affected but few GI symptoms
  • multiply on mononuclear phagocytes of Peyers patches
  • spread to liver gallbladder (carrier state), and spleen = bacteremia - FEVER and LPS induces symptoms
40
Q

How does salmonella typhi multiply and spread through body?

A

multiplies and spreads inside/via phagocytes

41
Q

Salmonella typhimurium - clinical presentation:

A

-incubation 12-48 hours
-ENTEROCOLITIS begins with nausea and vomiting
then abd pain and diarrhea (with or without BLOOD)
-if blood you need to intervene
-last several days and self limited

42
Q

Who is at greatest risk for severe Salmonella typhimurium infection?

A

Enterocolitis severe/like threatening in the very young and very old

43
Q

Salmonella typhi - clinical presentation:

A

-onset much slower that typhimurium
-flu like symptoms first
-sometimes constipation
-YES fever
- ROSE SPOTS
if bacteremia becomes high=
-high fever delirium, tender abdomen
-Liver function is abnormal

44
Q

Patient has ROSE SPOTS among other symptoms – what is the organism?

A

salmonella typhi!

45
Q

Treatment for

1) general enterocolitis:
2) enteric fevers, septicemia, severe enterocolitis

A

1) -self limiting - just give fluid and electrolytes
- antibiotics do not shorten or reduce symptoms –> instead could prolong fecal shedding and possibility for carrier state
- Only give antibiotics if septicemia risk
2) ceftriaxone or ciproflaxin
- chronic carriers of typhi = ampicillin or ciprofloxacin
- may need to perform cholecytectomy to get rid of carrer state

46
Q

How is resistance transmitted with salmonella?

A

plasmid mediated antibiotic resistance

47
Q

E Coli -

1) organism details?
2) where found in environemtn?
3) causes what?
4) antigens which characterize it?

A

1) -gram neg rod
- ferments lactose = pink on macconkeys
- faculative anaerobe
2) normal GI flora
3) Gastroenteritis, UTI…
4) O (cell wall); H (flagellar); K (capsule)

48
Q

most travelers diarrhea caused by?

A

enterotoxigenic E Coli (ETEC)

49
Q

most common cause of diarrhea in infants?

A

ETEC!

50
Q

ETEC gastroenteritis - patient presentation:

A
  • nausea
  • vomitin
  • abd cramping
  • massive watery diarrhea = dehydration
  • NO BLOOD
51
Q

Infective process of GI tract- ETECi:

A
  • Use adhesins to bind mucosa
  • release 2 toxins - similar to cholera toxin
  • small intestine involved
52
Q

EIEC ( enteroinvasive E Coli) - presentation, where infect?

A
  • like shigella infection -

- organism enters and grows in large intestine epithelium = cell death

53
Q

EIEC presentation in patient:

A
  • fever
  • cramps
  • BLOOD AND PUS IN FECES
54
Q

EPEC (enteropathogenic E Coli) - most common associations?

A
  • diarrheal outbreaks in hospital nurseries

- bottle fed infants in dev countires

55
Q

EPEC - what does it cause? What population?

A

-in infants = CHRONIC watery DIARRHEA w/ mucous

56
Q

EPEC - where infect & how?

A
  • has plasmid dependent adhesins = LOSS OF MICROVILLI AT SITE OF ATTACHEMNT bc of actin bundle change of shape (pedestal formation)
  • Small intestines
57
Q

Infant with watery diarrhea w/ pus - what organism?

A

EPEC

58
Q

EHEC ( enterohemorrhagic E Coli) - most important serotype?

A

O157:H7

59
Q

EHEC - infection process?

A

produces toxins similar to Shigella – EHEC toxins= shiga like toxins (SLT-I and II)

-infects large intestines

60
Q

EHEC - patient presentation?

A
  • BLOODY DIARRHEA NO PUS

- hemolytic uremic syndrome (due to toxins) = kidney failure and lysis of RBC

61
Q

E Coli- usual treatments:

A
  • replace fluids

- antibiotics should not be used routinely

62
Q

E Coli with infants treatment

A

fluids and gentamycin or polymyxin

63
Q

E Coli - travelers diarrhea treatment

A

bismuth or fluoroquinolones

64
Q

Cholera - symptoms/patient presentation:

A

Severe watery diarrhea - RICE WATER STOOL

-NO PMNs IN POOP

65
Q

Patient presents with rice water stools?

A

-cholera!

66
Q

Vibrio cholerae - organism details:

A

curved gram neg rod

67
Q

vibrio cholerae - pathogenesis?

A
  • exotoxin = cholera toxin=
    • A-B subunit - B binds and A activates adenylate cyclase = more cAMP
    • heat labile
68
Q

Cholera treatment:

A

-REPLACE FLUID AND ELECTROLYTES

69
Q

Campylobacter jejuni

-associate with which food?

A

CHICKEN

70
Q

Does campylobacter jejuni cause diarrhea?

A

ERR YES – dysentery

71
Q

Campylobacter jejuni- organism details:

A

curved gram neg rod

motile

72
Q

**Which organism can grow under MICROAEROPHILIC conditions?

A

**Campylobacter jejuni

H. pylori too

73
Q

Someone went out to eat, got some kind of GI bug, and got better in less than ten days - most likely organism?

A

-campylobacter jejuni

74
Q

Campylobacter jejuni - treatment -

A

usually gets bettter on its own – if severe give erythromycin or ciproflaxin

75
Q

H. pylori- organism details:

causes what?

A
  • gram neg
  • microaerophilic
  • short, spiral
  • multiple sheathed polar flagella

stomach ulcers!

76
Q

How does H pylori infect/pathogenensis?

A

-survive stomach acidity with urease - creates alkaline environemtn making urea into ammonia

GI Exam 1 (11 decks)

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