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Maddy - GI II Exam I - some pharm > Clin - Acute Infectious Diarrhea > Flashcards

Clin - Acute Infectious Diarrhea Flashcards

1
Q

cornerstone of diagnosis in acute infectious diarrhea

A

microbiologic analysis of the stool

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2
Q

what bacteria are tested for in a routine stool culture

A
  • salmonella
  • shigella
  • E. coli
  • campylobacter
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3
Q

if stool studies are unrevealing in acute infectious diarrhea, what diagnostic test should you do

A

endoscopy

  • flexible sigmoidoscopy w/ biopsies
  • upper endoscopy w/ duodenal aspirates and biopsies
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4
Q

what do abd x-rays check for in acute infectious diarrhea

A

detect free intraperitoneal air

- assess for ileus or toxic megacolon

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5
Q

what do abd CTs check for in acute infectious diarrhea

A

colitis

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6
Q

bacteria found in uncooked foods, lunch meat, or soft cheeses

A

listeria

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7
Q

pathogens found in raw seafood

A
  • vibrio species
  • salmonella
  • acute hepatitis A
  • norwalk virus
  • campylobacter
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8
Q

gram stain of s. aureus

A

gram positive cocci in clusters (like grapes)

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9
Q

sx of s. aureus ingestion

A

1) watery diarrhea
2) N/V
(rapid onset within 6 hrs of ingestion)

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10
Q

bacteria in cream pastries, potato salad, mayo

A

s. aureus

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11
Q

gram stain of b. cereus

A

gram positive rods

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12
Q

sx of bacillus cereus ingestion

A

1) watery diarrhea
2) vomiting (main sx)
(rapid onset within 6 hours of ingestion)

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13
Q

bacteria in fried rice

A

b. cereus

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14
Q

gram stain clostridium perfringens

A

gram positive spore-forming rod

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15
Q

sx of clostridium perfringens ingestion

A

1) watery diarrhea
2) crampy abd pain
(rapid onset within 8-16 hours of ingestion)

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16
Q

risk factors for clostridium perfringens ingestion

A
  • beef, ham, poultry, legumes, gravy

- inadequately cooked food (it is HEAT RESISTANT)

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17
Q

gram stain shigella

A

gram negative rods

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18
Q

sx of shigella

A

1) watery diarrhea that becomes bloody
2) abd cramps
3) fever for 3-4 days

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19
Q

diagnostic tests for shigella

A

1) fecal leukocytes

2) stool culture

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20
Q

where is shigella found in food

A

potato or egg salad, LETTUCE, raw vegetables

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21
Q

tx for shigella

A

bismuth, ampicillin, fluoroquinolone

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22
Q

complications of shigella

A

reactive arthritis and HUS

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23
Q

gram stain salmonella typhimurium

A

gram negative, non-lactose fermenting, motile, rod shaped

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24
Q

are antibiotics indicated in salmonella typhimurium

A

nope

typhimurium is the non-typhoid salmonella

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25
Q

what patients are at increased risk for salmonella typhimurium

A

1) sickle cell patients
2) leukemia pts
3) HIV

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26
Q

complications of salmonella typhimurium

A

1) reactive arthritis
2) endocarditis
3) septic arthritis
4) abscesses
5) osteomyelitis

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27
Q

what food and animal exposures increases risk for salmonella typhimurium

A
  • eggs, poultry

- reptiles (turtles)

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28
Q

gram stain salmonella typhi

A

gram negative rod, anaerobic

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29
Q

sx salmonella typhi

A

typhoid fever 7-14 days after ingestion

  • 2 symptomatic phases separated by asymptomatic phase
    1) sustained 103-104 fever
    2) weakness, HA, anorexia, RUQ pain, maculopapular rash, pea-soup diarrhea –> bloody diarrhea
    3) encephalopathy, splenomegaly, conjuctivitis
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30
Q

diagnostic tests for salmonella typhi

A

1) stool culture

2) blood culture

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31
Q

gram stain c. jejuni

A

gram negative curved/spiral-shaped rod

spiral shaped or comma shaped

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32
Q

associated with guillian-barre syndrome

A

campylobacter jejuni

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33
Q

gram stain v. cholerae

A

gram negative bacilli, anaerobic, curved/comma shaped, with flagellum

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34
Q

tx vibrio cholerae

A

rehydration/electrolyte replacement

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35
Q

gram stain vibrio parahemolyticus

A

gram negative bacilli w/ cytotoxin production

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36
Q

sx vibrio parahemolyticus

A
  • N/V/abd cramps
  • water –> bloody diarrhea
    (lasts 2-5 days)
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37
Q

what foods can harbor vibrio parahemolyticus

A

seafood

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38
Q

gram stain vibrio vulnificus

A

gram negative bacillus

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39
Q

sx vibrio vulnificus

A
  • vomiting/diarrhea/abd pain

- pt with open wound in the water

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40
Q

risk factors for vibrio vulnificus

A

coastal salt water, raw shellfish

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41
Q

gram stain aeromonas hydrophila

A

gram negative bacillus, non-spore forming, facultatively anaerobic bacteria, motile w/ flagellum

42
Q

sx aeromonas hydrophila

A

two types:

1) cholera like (non blood diarrhea, water rice water stools)
2) bloody mucoid stools

43
Q

tx aeromonas hydrophila

A

ampicillin

44
Q

risk factors for aeromonas hydrophila

A

1) fresh water environment
2) eating fish or shellfish
3) open wounds in water (foot and ankle most common)

45
Q

scuba diver that swallowed small amounts of fresh water and then developed gastroenteritis

A

aeromonas hydrophila

46
Q

visitors to russia who develop diarrhea

A

giardia

47
Q

tx ETEC

A
  • antibiotics

- bismuth

48
Q

diagnostic results in EHEC

A

1) peripheral leukocytes, anemia, thrombocytopenia
2) fecal leukocytes
3) fecal lactoferrin
4) shiga like toxin in stool culture

49
Q

tx EHEC

A

1) supportive
2) rehydration
3) antibiotics only in severe cases (antibiotics can increase risk of HUS)

50
Q

complications of EHEC

A

HUS

51
Q

gram stain yersinia enterocolitica

A

gram negative coccobacili

52
Q

abd cramping and pharyngitis

A

yersinia enterocolitica

53
Q

what dz can yersinia enterocolitica mimic

A

appendicitis

54
Q

what patients have higher risk for yersinia enterocolitica

A

those with derangements in iron metabolism

  • iron overload syndromes
  • cirrhosis
  • hemochromatosis
  • aplastic anemia
  • thalassemia
55
Q

gram stain listeria monocytogenes

A

gram positive rod

56
Q

sx listeria monocytogenes

A

1) fever
2) non bloody diarrhea
3) headache, N/V

57
Q

risk factors for listeria monocytogenes

A
  • pregnant women
  • extremes of age
  • immunocompromised
  • hemochromatosis
58
Q

gram stain tropheryma whipplei

A

gram positive bacillus, not acid fast

59
Q

diagnostic test for tropheryma whipplei

A

EGD with biopsy and periodic acid schiff (PAS)

60
Q

sx tropheryma whipplei

A

1) fever
2) arthralgias
3) weight loss
4) malabsorption
5) chronic diarrhea

61
Q

tx for tropheryma whipplei

A

antibiotics w/ drugs that cross the BBB

62
Q

prognosis of tropheryma whipplei

A

if untreated, dz is fatal

63
Q

gram stain c. difficile

A

anaerobic gram positive spore forming bacilli

64
Q

diagnostic test for c. difficile

A

stool assay - PCR for toxin (A and B)

65
Q

complications of c. diff

A

toxic megacolon

66
Q

most common cause of acute diarrhea in infants (children <2)

A

rotavirus

67
Q

virology of rotavirus

A

dsRNA

68
Q

sx rotavirus

A

vomiting and watery diarrhea

69
Q

“wagon-wheel” appearance on electron microscopy

A

rotavirus

70
Q

virology adenovirus

A

dsDNA

71
Q

sx adnovirus

A
  • watery diarrhea and vomiting
  • conjuctivitis
  • pharyngitis
72
Q

virology norovirus

A

small non-enveloped RNA virus

73
Q

virology CMV

A

herpesvirus family: dsDNA (linear)

74
Q

sx cytomegalovirus

A

fever, abd pain, bloody diarrhea

75
Q

most common cause of dysentery in the world

A

entamoeba histolytica

76
Q

parasitology of entamoeba histolytica

A

trophozoite

77
Q

“flask-shaped” ulcer on histology

A

entamoeba histolytica

78
Q

risk factors for entamoeba histolytica

A

1) mental health institutions
2) poor sanitation
3) contaminated food/water
4) endemic areas

79
Q

complications of entamoeba histolytica

A

1) toxic megacolon

2) pneumatosis coli

80
Q

parasitology of giardia lamblia

A

pear-shaped, 4 flagella, 2 nuclei protozoan (trophozoite)

81
Q

risk factors giardia lamblia

A

1) water - hiking/camping
2) beavers, cattle, dogs, rodents, big horn sheep
3) daycare
4) contaminated water in russia
5) IgA deficiency pts

82
Q

parasitology of cryptosporidium parvum

A

oocyst with 4 motile sporozoites

83
Q

risk factors cryptosporidium parvum

A

1) swimming pools

2) daycare

84
Q

parasitology strongyloides stercoralis

A

nematode (roundworm)

- enters through bare feet

85
Q

risk factors strongyloides stercoralis

A

pts with HTLV-1

86
Q

sx cyclospora cayetanensis

A

1) watery diarrhea

2) malaise, anorexia, nausea, low grade fever

87
Q

risk factors cyclospora cayetanensis

A

1) lettuce, fresh basil, imported raspberries
2) tx of water or food w/ chlorine or iodine is unlikely to kill cyclospora cayetanensis
3) endemic areas

88
Q

sx cytoisospora belli

A

1) non-bloody water diarrhea

2) crampy abd pain

89
Q

risk factors for cytoisospora belli

A

tropical and subtropical areas

- spread by ingesting contaminated food or water

90
Q

what parasite can cause B12 deficiency

A

diphyllobothrium latum

91
Q

sx and transmission of schistosoma mansoni

A

1) 2nd most common cause of esophageal varices in africa

2) contaminated freshwater snails

92
Q

sx schistosoma mansoni

A

blood stools, bladder CA, liver cysts

93
Q

compare sx b/w taenia solium and taenia saginata

A

solium: mostly asymptomatic, but rarely cause seizures and muscle or eye dz
saginata: mostly asymptomatic

94
Q

transmission and sx of echinococcus granulosus

A
  • sheep, dogs, poor sanitation

- cysts in liver or lungs

95
Q

in what patients should you prescribe anti-motility agnets

A

those without fever and non-blood stools

NOT in c. diff or EHEC

96
Q

nutrition recommendations for infectious diarrhea

A

1) BRAT diet (bananas, rice, applesauce, toast)
2) easily digestible foods (potatoes, crackers, yogurt, soup)
3) rice water

97
Q

alcohol gels for hand sanitation are ineffective against what pathogens

A

C. diff and norovirus

98
Q

what pathogens cause reactive arthritis (Reiter’s syndrome) with arthritis, urethritis, and conjuctivitis

A
  • salmonella
  • campylobacter
  • shigella
  • yersinia
99
Q

compare sx b/w pathogens infecting the small bowel and large bowel

A

small bowel: large volume, watery stools, and cramps, weight loss, dehydration/malabsorption, no WBCs

large bowel: frequent small volume stools, may have: fever, blood or WBCs in stool, fecal leukocytes

100
Q

pts with hemochromatosis are at risk for what pathogens

A

vibrio species, listeria, yersinia

Maddy - GI II Exam I - some pharm (23 decks)

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