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GI II Final - Mik > Bugs > Flashcards

Bugs Flashcards

1
Q

S. aureus

shape & stain, toxins, symptoms, contraction

A 
Gram + cocci in clusters
preformed enterotoxins
N/V, watery diarrhea
rapid onset within 6 hours;
rapid resolution 24-48 hours
Contracted from ham, poultry, dairy, EGGS, CREAM PASTRIES, POTATO SALAD, MAYONNAISE
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2
Q

Bacillus cereus

shape & stain, toxins, symptoms, contraction

A 
Gram + rods
Preformed enterotoxins
Vomiting (mainly), watery diarrhea
Rapid onset within 6 hours;
rapid resolution 24-48 hours
Contracted from FRIED RICE, meats, veggies, dried beans, cereals
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3
Q

Clostridium perfringens

A

Gram + spore-forming rods
Preformed enterotoxins
Watery diarrhea (no fever or vomiting), crampy abd pain
Rapid onset within 8-16 hours;
Rapid resolution within 24-48 hours
Contracted from beef, ham, poultry, legumes, gravy (inadequately cooked)

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4
Q

Shigella spp
shape & stain, toxin, Symptoms, Contraction,
Dx, Tx, Complications

A

Gram - Rods, nonmotile
Shiga toxin
dystentery: bloody diarrhea (begins watery -> bloody with fever), abd cramps
Lasts 1-2 weeks
Tests: fecal leukocytes +, lactose - on stool culture
Tx: bismuth, ampicillin, fluoroquinolone, or trimethoprim/sulfamethoxazole
Complications: respiratory complaints and seizures (children), reactive arthritis, HUS

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5
Q

Reactive arthritis

A

Can’t see, can’t pee, can’t climb a tree

  • conjunctivitis - discharge, erythema, burning, photophobia
  • urethritis - dysuria, urgency, frequency, discharge
  • arthritis - knees/ankles/feet
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6
Q

Salmonella typhimurium

shape & stain, symptoms, contraction, Dx, Tx, complications

A

gram -, non-lactose fermenting, motile, rod-shaped
watery -> bloody diarrhea, fever, abd cramping, N/V
Lasts 5-10 days, self-limited
Fecal leukocytes +
Contraction by food, esp EGGS, POULTRY, milk/dairy products, beef, shellfish or from animals - TURTLES, ducks, birds
Increased risk with immunocompromised (esp sickle cell)
Labs: stool culture
Do NOT give antibiotics
Complications: reactive arthritis, endocarditis, septic arthritis, osteomyelitis

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7
Q

Salmonella typhi

shape & stain, transmission, symptoms, Dx, Tx

A

gram - rod
International travel (humans are the only carrier), poor sanitation, fecal-oral
Sx: typhoid fever: systemic sustained febrile, high ever, weakness, headache, anorexia, RLQ pain, rash of flat rose-colored spots, diarrhea
Dx: samples of stool or blood; fecal leukocyte +
Tx: fluoroquinolones, ceftriaxone, azithromycin

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8
Q

Campylobacter jejuni

shape & stain, transmission, Sx, Dx, Tx, complications

A

gram - curved/spiral shaped rod
ingestion of raw/undercooked meat (POULTRY), diary (raw milk), birds and ducks are hosts, cross-contamination during food prep, contaminated water
Self-limited watery -> bloody diarrhea, fever, cramps abd pain
Dx: stool culture with campy blood agar, oxidase +, motile
Tx: supportive
Complications: 1-8 weeks post diarrhea: reactive arthritis, Guillian-Barre Syndrome

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9
Q

Vibrio cholerae

shape & stain, Sx, transmission, Dx, Tx

A

gram - bacilli, anaerobic, curve/comma shaped with flagellum
N/V, abd cramping, profuse watery (rice water) diarrhea, dehydration
12-48 hour incubation
waterborne illness (saltwater); eat raw oysters, sewage)
Duration: 1 week
Dx: stool microscopy
Tx: rehydration, antibiotics

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10
Q

Vibrio Parahemolyticus

shape & stain, toxin, transmission, Dx, Sx

A

gram - bacilli
cytotoxin production
Sx: N/V, abd cramps, watery -> bloody diarrhea
Dx: fecal leukocyte +, stool culture
Lasts 2-5 days
Sea-food associated: shellfish, oysters, shrimp

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11
Q

Vibrio Vulnificus

shape & stain, transmission, Sx

A

gram - bacillus
transmitted in coastal salt water through open wounds, and eating raw shellfish (oysters)
Sx: vomiting, diarrhea, abd within 16 hours of ingestion, bullies skin lesions
*life-threatening in immunocompromised (esp cirrhosis and hemochromatosis)

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12
Q

Aeromonas hydrophila

shape & stain, transmission, Sx, Tx

A

gram -, non-spore forming, rod-shaped, motile
fresh water environment, eating fish or shellfish, foot and ankle wounds in water
Sx: necrotizing fasciitis, cholera-like (watery rice water stools) OR bloody mucoid stools
Tx: ampicillin

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13
Q

Causes of Travelers diarrhea

A

most common = ETEC
Others: campylobacter (Asia), salmonella, shigella, aeromonas, EAEC, coronavirus, Giardia (Russia, campers, backpackers, swimmers in wilderness), Cyclospora (Nepal), Norovirus (cruise ships)

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14
Q

ETEC

shape & stain, transmission, Sx, Dx, Tx

A

gram - rod
ingestion of contaminated food or water
Sx: N, occasional fever & vomiting, watery diarrhea
Sudden onset, 3-6 day duration
Dx: fecal leukocyte -
Tx: Antibiotics (trimethoprim/sulfamethoxazole, doxycycline, ciprofloxacin), bismuth

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15
Q

EHEC

shape & strain, toxin, transmission, Sx, Tx, complications

A

(O157:H7) gram - rod, shiga-toxin
food-borne: undercooked meat, raw veggies, raw milk, unpasteurized apple cider
animal contact
Sx: watery -> bloody diarrhea -> ischemic colitis, no fever, peripheral leukocytes +, fecal leukocytes +
Tx: supportive, rehydration
Complications: HUS 5-10 days into course; more likely in kids and if treated with antibiotics

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16
Q

Other E. coli

A

EAEC - persistent diarrhea in kids
EPEC - infantile watery or bloody diarrhea
EIEC - fever, abd pain, watery -> bloody diarrhea with leukocytes (dysentery)

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17
Q

Yersinia enterocolitica

shape & strain, transmission, Sx, Dx, Tx, complications

A

gram - coccobacilli
transmission by contaminated food/water or dairy, contaminated domestic animal feces
Sx: bloody diarrhea, fecal leukocytes +, fever, cramps, N/V, Abd pain & pharyngitis
Duration 10-20 days
Dx: stool/blood cultures
Tx: supportive care
Complications: rash, reactive arthritis
Note** - higher risk in those with derangements of iron metabolism, diabetes, and preexisting GI disorders
Note** - can mimic appendicitis

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18
Q

Listeria monocytogenes

shape & strain, transmission, Sx, Dx, Tx, Complications

A

gram + rod
get from contaminated food (raw milk, unpasteurized diary, and deli meats)
Sx: fever, non-bloody diarrhea, headache, N/V 2-3 days duration
Dx: blood culture or CSF, stool cultures
Tx: ampicillin and trimethoprim/sulfamethoxazole
Complications: causes meningoencephalitis and listeria placentis

  • Note it has a predilection for pregnant women, extremes of age, immunosuppressed, and those with hemochromatosis
  • Note that this can grow at cold temps
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19
Q

Clostridium difficile

shape & strain, toxin, transmission, Sx, Dx, Tx, complications

A

anaerobic, gram +, spore-forming bacillus
Cytotoxin production (exotoxin mediated)
Transmission: within last 2 months - hospital stay or ill contact? antibiotic use? Especially clindamycin, cephalosporins, and fluoroquinolones? PPI?
Sx: watery diarrhea, abd pain, fever, peripheral leukocyte +, pseudomembranes on colonic mucosa
Dx: stool - PCR for toxin
Tx: PO or IV metronidazole, PO vancomycin
Complication: toxic megacolon

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20
Q

Rotavirus

type, age, transmission, Sx, Dx, Tx

A

double stranded RNA virus
infants (children < 2), can occur in adults
spread via fecal-oral
Sx: vomiting and watery diarrhea, severe dehydration, fecal leukocytes -
symptoms begin within 72 hours and last 2-3 days, up to 5
Dx: viral culture or PCR, “wagon wheel” appearance on electron microscopy
Tx: supportive care

  • Note: death can occur by dehydration
  • Note: most common cause of acute diarrhea in infants
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21
Q

Adenovirus

type, age, Sx, Dx, Tx

A 
double stranded DNA virus
children
Sx: fever, chills, myalgias, sore throat, watery diarrhea, vomiting, conjunctivitis, pharyngitis
prolonged course (10 days)
Dx: viral culture
Tx: supportive

*Note: most common cause of viral conjunctivitis in children

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22
Q

Norwalk/Norovirus

type, age, transmission, Sx, Tx

A

small non-enveloped RNA virus
older children and adults
fecal-oral transmission; outbreaks via contaminated food, water, person-person
Sx: vomiting, watery diarrhea (4-8 stools/day)
symptoms within 24-48 hours, lasts 3 days
Tx: supportive care

*Note: strong association with nursing homes, child care centers, schools, and CRUISE SHIPS

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23
Q

Cytomegalovirus

type, population, Sx, Dx

A

herpes virus family - double-stranded linear DNA
primarily immunosuppressed/AIDS patients, CD4 < 200
Sx: fever, abd pain, bloody diarrhea
persists for several weeks
Dx: endoscopy with biopsy of ulcerated lesions using CMV stains

24
Q

Entamoeba histolytica

characteristic, transmission, Sx, Dx, Tx, complications

A

“flask-shaped ulcer”
Transmitted fecal-oral in crowded living conditions
Endemic in Asia, Africa, Central and South America
Sx: fever, tenesmus, bloody diarrhea, abd pain, fecal leukocyte +
Persists for days-weeks
Dx: stool for ova and parasite, stool Ag (PCR for DNA)
Tx: metronidazole and paromomycin
Complications: can penetrate bowel -> portal circulation -> liver abscesses, toxic megacolon or pneumatosis coli

*Note: most common cause of dysentery in the world

25
Q

Giardia lamblia

characteristic, transmission, Sx, Dx, Tx

A

pear-shaped, 4 flagella, 2 nuclei protozoan
fecal-oral transmission, acquired through water (lakes and streams), hiking/camping, beavers, Russia, daycares
Sx: watery (malodorous) diarrhea, steatorrhea, flatulence, abd pain, belching, weight loss, nausea, malaise, cramps, anorexia, bloating, fecal leukocyte -
lasts 14-28 days
Dx: check stool for ova parasites, stool Ag detection
Tx: metronidazole

26
Q

Cryptosporidium (self-limited and life-threatening)

population, transmission, Sx, Dx, Tx

A

life-threatening in immunosuppressed patients (AIDS CD4 < 200)
transmission: water borne organisms, contaminated food/water, outbreaks with swimming pools, unsanitary milk production, municipal water supplies, person-person
Sx: nausea, malaise, abd cramping, large volume of watery diarrhea, fecal leukocyte -
(in AIDS patients -> biliary Dz also)
Dx: stool Ag detection or direct microscopy
modified acid-fast staining, direct fluorescent Ab
Tx: supportive care, AIDS = antivirals to increase CD4

27
Q

Strongyloides stercoralis

type, transmission, Sx, Dx, Tx

A

nematode: roundworm
enter body through exposed skin from contaminated soil
Risk factors: poor, rural, institutionalized, immunocompromised
Sx: Abd pain, bloating, diarrhea, cough, SOB, perianal urticaria, migratory rash
Dx: rhabditiform larvae in stool, eosinophils in stool
Tx: anti-helminthic

28
Q

Cyclospora cayetanensis

transmission, Sx, Dx, Tx

A

transmitted via produce imported from endemic areas: lettuce, basil, raspberries, travel to endemic areas: tropical and subtropical regions
Sx: malaise, anorexia, nausea, low fever, watery diarrhea, fecal leukocytes -
can last 21 days in immunocompetent, indefinitely in immunosuppressed
Dx: oocysts in stool sample
Tx: TMP/SMX

29
Q

Cystoisospora belli

endemic, transmission, Sx, Dx, Tx

A

Most common in tropical and subtropical areas
Spread by contaminated food or water
Sx: acute, non-bloody, watery diarrhea with abd cramping
can last for weeks -> malabsorption & weightless, eosinophilia
Dx: repeat stool examinations for oocysts
Tx: TMP/SMX

30
Q

Ascaris lumbricoides

type, transmission, Sx

A

hookworm, fecal oral transmission, can cause bowel obstruction

31
Q

Diphyllobothrium latum

type, transmission, Sx

A

fish tapeworm, transmission with raw/undercooked fish, can cause B12 def -> pernicious anemia

32
Q

Schistosoma mansoni

endemic, transmission, Sx

A

Africa, transmitted by freshwater snails through skin, causes bloody stools, bladder cancer, liver cysts

*Note: 2nd most common cause of esophageal varies in Africa

33
Q

Taenia solium

type, Sx

A

pork tapeworm, mostly asymptomatic -> rare, serious cases of seizures and muscle or eye disease

34
Q

Echinococcus granulosus

type, transmission, Dx

A

tapeworm
transmitted by unsanitary livestock, especially sheep and dogs, humans are infected fecal-oral, poor sanitation through infected dogs
form cysts in liver or lungs
looks like free-flowing “hydatid sand” on CT

35
Q

Name the symptoms of a pathogen that commonly affects the small bowel

A

Presents with: large volume, watery stools, abdominal cramps, weight loss, fecal leukocytes -, mid abdomen or diffuse pain, dehydration/malabsoprtion

36
Q

Name examples of pathogens that commonly affect the small bowel (15)

A

Salmonella, Vibrio cholerae, ETEC, EPEC, Yersinia, Rotavirus, Norovirus, CMV, Adenovirus, Giardia, Cryptosporidium, Cyclospora, Clostridium perfringens, Staph aureus, Bacillis cereus

37
Q

Name the symptoms of a pathogen that commonly affects the large bowel

A

Presents with: frequent, small volume stools

May be associated with fever, blood in stool, fecal leukocyte +, lower abd or rectum pain

38
Q

Name examples of pathogens that commonly affect the large bowel (12)

A

Campylobacter, Salmonella, Shigella, Yersinia, EIEC, EHEC, C. diff, Vibrio parahaemolyticus, E. histolytic, CMV, Adenovirus, Herpes simplex

39
Q

What infections are AIDS patients more likely to acquire? (10)

A

Cryptosporidium, Cystoisospora belli, Cyclospora, Salmonella, Campylobacter, Shigella, Mycobacterium avium complex, CMV, Herpes, Adenovirus

40
Q

What infections are patients with hemochromatosis more likely to acquire? (3)

A

Vibrio species, Listeria, Yersinia infections

41
Q

HAV

family, prodrome, duration, risk factors, Sx, Labs, vaccine, acute/chronic, mortality

A

family: hepatovirus/picornavirus family, single stranded RNA genome
prodrome: anorexia, N/V, malaise, aversion to smoking
Duration: 2-3 weeks
Risk factors: international travel, contaminated water or food, shellfish
Sx: fever, malaise, myalgia, arthralgia, UR, anorexia, enlarged and tender liver, jaundice, N/V, diarrhea/constipation
Labs: markedly elevated AST/ALT, mild proteinuria, bilirubinuria, anti-HAV Ab, IgG anti-HAV (in the absence of IgM) indicates previous exposure
Vaccine: HAV vaccine in US
Acute only
Low mortality

42
Q

HBV

family, prodrome, duration, risk factor, Sx, Transmission, Labs, Vaccine, acute/chronic, complications

A

Family: hepadnavirus, partially double-stranded DNA genome
Prodrome: anorexia, N/V, malaise, aversion to smoking
Duration: 2-3 weeks
Risk factors: men who have sex with men, those at hemodialysis centers, previously incarcerated, previously treated for STI, drug abusers
Sx: low grade fever, enlarged and tender liver, jaundice; may also be associated with glomerulonephritis, serum sickness, and polyarteritis nodosa
Transmission: endemic in Africa and Southeast Asia
Labs: markedly elevated aminotransferases early in course
Vaccine: yes
90% acute & recover
Complications: cirrhosis, HDV superinfection, hepatocellular carcinoma (men > women)

43
Q

What does the HBV serology look like during the window period?

A

HBsAg -, Anti-HBs -, Anti-HBc IgM +, Anti-HBc IgG -, HBeAg -, HBV DNA -

44
Q

What does the HBV serology look like during the acute infection?

A

HBsAg +, Anti-HBs -, Anti-HBc IgM +, Anti-HBc IgG -, HBeAg +, HBV DNA +

45
Q

What does the HBV serology look like with prior infection?

A

HBsAg-, Anti-HBs +, Anti-HBc IgM -, Anti-HBc IgG +, HBeAg -, HBV DNA -

46
Q

What does the HBV serology look like with chronic infection?

A

HBsAg +, Anti-HBs -, Anti-HBc IgM +, Anti-HBc IgG +, HBeAg +, HBV DNA +

47
Q

What does the HBV serology look like with immunization?

A

HBsAg -, Anti-HBs +, Anti-HBc IgG -, Anti-HBc IgG -, HBeAg -, HBV DNA -

48
Q

What does HBsAg indicate?

A

surface Ag, first evidence of infection, positive during acute and carrier (chronic) state

49
Q

What does HBsAb indicate?

A

surface Ab, immunity to HBV

50
Q

What does HBcAg indicate? HBcAg IgM/IgG?

A

core Ag
IgM = appears shortly after HBsAg is detected, only thing detectable during the GAP/Window period -> considered acute HBV
IgG = appears during late in acute phase and persists indefinitely whether person gets chronic infection or immunity (prior infection)

51
Q

What does HBeAg indicate?

A

correlates with viral proliferation and infectivity, positive during acute and active chronic, negative in the inactive chronic carrier state

52
Q

What does HBV DNA indicate?

A

detectable during current infection, typically parallels the presence of HBeAg

53
Q

HDV

family, risk factors, labs, vaccine, mortality

A

Family: defective virus that requires HBV for replication
Risk Factors: co-infects with HBV or supenrinfects those with HBV, endemic along Mediterranean Basin where it spreads non-percutaneously
Nonendemic areas it spreads percutaneously in HBsAg+ IV drug users or hemophiliac transfusion
Labs: Anti-HDV serum
Vaccine: vaccinate against HBV
Mortality: enhances severity of HBV

54
Q

HEV

Family, Duration, Risk Factors, Transmission, Labs, Acute/Chronic, Mortality, Complications

A

Family: RNA hepevirus
Duration: self-limited
Risk Factors: epidemic form in Asia, Middle East, North Africa, Central America, India; having a pet in the home or consuming undercooked organ meat are risk factors
Transmission: enterically - waterborne epidemics, undercooked meat, spread by swine
Labs: IgM anti-HEV
Acute/Chronic: acute, no carrier state
Mortality: high in pregnant women
Complications: arthritis, pancreatitis, thrombocytopenia, Guillian Barre, peripheral neuropathy

55
Q

HCV

Family, Duration, Risk Factors, Sx, Labs, Acute/Chronic, Complications, Tx

A

Family: flavin-like virus
Duration: most commonly chronic
Risk Factors: not sexual, confection with HIV-infected persons, IV drug use, body piercing, tattoos, hemodialysis
Sx: clinically mild and asymptomatic
Labs: Anti-HCV in serum; most sensitive = HCV RNA, enzyme immunoassay that detects Abs to HCV
Acute/Chronic: >50% likelihood of chronicity
Complications: cirrhosis, hepatocellular carcinoma, HIV co-infection, mixed cryoglobulinemia, chronic HCV infection is associated with a decrease in serum cholesterol
Tx: curable

GI II Final - Mik (1 decks)

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