Bacterial Pathogens GI 2

Question 1

Your neighbor, 70 year old Becca is now in a nursing home. You visit her one morning. She doesn’t look too good. She tells you she has been on Clindamycin for about 6 days now (for some respiratory bug). Since last night, she has had multiple episodes of watery diarrhea. Her stool was mucoid, looked green and had blood. It also smelled bad. She had a low grade fever and abdominal pain and cramps.

Answer 1

Clostridiodes difficile

Question 2

C. Diff Diagnosis

Answer 2

• ELISA for Toxin A/B + GDH antigens

- PCR

Question 3

C. Diff Tx

Answer 3

• Stop current Abx
• start metronidazole, vancomycin, or fidaxomicin
• Zinplava for high recurrence risk and/or Fecal transplant

Question 4

C. Diff path

Answer 4

Toxins disrupt cell cytoskeleton resulting in loss of adherence + weakening of cell tight junctions leading to diarrhea, inflammation, and death

Question 5

Y. Enterocolitica Presentation

Answer 5

• Raw/undercooked Pork
• untreated water
• S/S: fever, pain, bloody diarrhea; RLQ pain; Pharyngitis

Question 6

Y. Enterocolitica Path

Answer 6

• Adherence to gut epithelium, invasions of gut wall, localization of lymphatics, + avoidance of Cell-mediated immunity.
• ## Urease + (gastric mucosa)

Question 7

Y. Enterocolitica LabDx

Answer 7

• Stool culture
• throat culture
• Blood cultures
• CIDTs
• Agglutinationa assay
• NO Serologic tests

Question 8

Y. Enterocolitica Treatment

Answer 8

• usually resolves on its own
• clinically significant strains are usually susceptible to other b lactam agents, aminoglycosides, tetracyclines, chloramphenicol, TMP-sulfamethoxazole, and fluoroquinolones

Question 9

Aggregatibacter actinomycetemcomitans

Answer 9

• Commensal of human mouth
• S/S:Can produce severe gum infection Localized juvenile periodontitis; acute necrotizing ulcerative gingivitis; Bacterial Endocarditis
• Tx: Amoxicillin + Metronidazole

Question 10

S. Aur food poisoning

Answer 10

• unpasteurized dairy
• Salty foods; Canned ham
• S/S develop 30 min - 6 H: N/V, cramps, diarrhea

Question 11

Bacillus Cerus intoxication

Answer 11

• Rice; other leftovers sat too long at room temp
• Tx: hydration/rest
• S/s: N/V 30 min - 6H followed by watery diarrhea + cramps

Question 12

C. Perf intoxication

Answer 12

• Pre-cooked meats; dried foods
• Kept warm for long periods of time before serving; “cafeteria, prisons, etc”
• No Fevr or vomiting; just diarrhea + cramps

Question 13

C. Bot intoxication PResentation

Answer 13

• Medical emergency
• 18 - 36 H after consumption
• Home-canned foods especially asparagus, green beans, beets, + corn
• S/S: vision disturbance, drooping eyelides, sluured speech, difficulty swallowing, dry mouth
• **Flaccid paralysis
• “Floppy” infant

Question 14

C. Bot LabDx

Answer 14

• Brain Scan
• Blood culture
• CSF culture
• Stool culture

Question 15

C. Bot Toxin/types

Answer 15

A,B,E, + F w/ A the most potent

Question 16

C. Bot Tx

Answer 16

• Supportive w/ mechanicl ventilation
• Antitoxin
• BabyBIG
• ** NO Abx!