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Clinical Pathology > CP11-9 GI Infections Part 2 > Flashcards

CP11-9 GI Infections Part 2 Flashcards

1
Q

What is the second leading cause of death in children under 5?

A

Diarrhoeal disease

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2
Q

what is the most common cause of diarrhoeal disease?

A

Non-food bourne e.g. hand hygiene

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3
Q

What are some physical factors to prevent diarhoeal disease?

A

Food and water hygiene
Hand washing
Animal contact

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4
Q

What are some host factors that can prevent diarrhoeal disease?

A

Healthy Microbiome
Stomach acid barrier
Local immune responses

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5
Q

What are some interventions used to prevent diarrhoeal disease?

A

Vaccines
Antimicrobial treatments
Rehydration therapies

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6
Q

What are some categories of disease causing gastroenteritis/diarrhoea?

A

Food borne
Non-foodborne
Viral
Waterborne
Antibiotic-associated

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7
Q

What are two subtypes of food borne/waterborne gastroenteritis?

A

Intoxication
Infection

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8
Q

What is the difference between intoxication and infection gastroenteritis?

A

Intoxication = ingestion of pre formed toxin with a rapid incubation period. Non communicable and causes more systemic symptoms.

Infection = ingestion of bacteria, virus or parasite with a slow incubation period. Communicable, usually faecal-orally, causing more localised systems in GI tract.

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9
Q

What causes intoxication gastroenteritis?

A

Inadequate cooking
Improper hand,ink temperatures

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10
Q

What causes you to get pathogens causing infectious gastroenteritis?

A

Inadequate cooking
Cross contamination e.g. of cooked and raw meat
Poor hygiene and hand washing

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11
Q

What foods are associated with gastroenteritis?

A

Dairy
Eggs
Meats including ground beef, poultry, pork
Seafood especially oysters
Some vegetables
Mayonnaise
Rice
Canned food including honey

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12
Q

Who is not allowed to have honey?

A

Children under 1 due to risk of foodbourne gastroenteritis

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13
Q

How does staph aureus cause gastroenteritis?

A

Heat stable enterotoxin of staph aureus causes nausea and vomiting (no diarrhoea) around 4 hours after ingestion.

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14
Q

What are the two type of bacillus cereus associated GI infection?

A

Heat stable emetic toxin = vomiting without diarrhoea 1-4 hours after eating cooked rice usually

Heat labile toxin = little vomiting but precise diarrhoea 12-14 hours after eating

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15
Q

How does clostridium perfringens cause gastroenteritis?

A

Causes abdominal cramps and watery diarrhoea 1-4 hours caused by heat labile toxins of c. Perfringes after eating contaminated meat products

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16
Q

How does clostridium botulinum cause gastroenteritis in adults?

A

Neurotoxin produced by c. Botulinum causes blurred vision, respiratory failure and flaccid paralysis 1-2 days after eating contaminated canned food

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17
Q

How does clostridium botulinum cause gastroenteritis in infants?

A

C botulinum spores - usually in honey - colonise the infant’s GI tract and produces toxins causing constipation and neurological symptoms (milder disease than adults)

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18
Q

How does salmonella cause gastroenteritis?

A

6-8 hours after eating high dose from contaminated poultry, birds and some reptiles causing cramps, diarrhoea, fever, myalgia, nausea and vomiting

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19
Q

What is the most common type of salmonella?

A

Salmonella enteritidis

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20
Q

How are intoxification food borne gastroenteritis treated?

A

With supportive measures as contaminated with toxin not actual pathogen

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21
Q

When are antibiotics given to salmonella associated gastroenteritis?

A

If affected individual is:
>50
Immunocompromised
Has cardiac valve disease or e do vascular abnormalities

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22
Q

What antibiotic is given to those who need it for salmonella associated gastroenteritis?

A

Ciprofloxacin

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23
Q

What gastroenteritis occurs from shingella species?

A

Dysentery = watery, bloody, mucoid stool with associated stomach pain. Causes fluid and enterolyte loss. Only requires small dose to become ill 36-72 hours after infection.

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24
Q

How is shingella associated gastroenteritis treated?

A

Only with antibiotics if individual has sever disease, is immunocompromised or has bloody diarrhoea

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25
Q

What antibiotic is given to patients with shingella associated gastroenteritis?

A

Ciprofloxacin

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26
Q

What should not be prescribed to patients with shingella associated gastroenteritis?

A

Anti motility drugs e.g. loperamide or diphenoxylate

27
Q

What is characteristic of campylobacter associated gastroenteritis?

A

Watery diarrhoea, nausea, vomiting, malaise and headache due to production of heat labile toxin 2-5 days after ingestion. Associated with poultry, birds and rascal oral transmission.

28
Q

How should campylobacter associated gastroenteritis be treated?

A

With fluid and electrolyte replacement if necessary
Antibiotics if severe or worsening symptoms, immunocompromised, or symptoms lasting >1 week

29
Q

What antibiotic is given to patients with campylobacter associated gastroenteritis who need it?

A

erythromycin

30
Q

What e.coli can cause gastroenteritis?

A

E.coli 0157

31
Q

How does e.coli 0157 cause gastroenteritis?

A

Found in contaminated cattle and meat and can produce shiga toxin causing watery diarrhoea and then bloody diarrhoea after 2-5 days.

32
Q

What are complications of e.coli 0157 associated gastroenteritis?

A

10-15% develop haemolytic uraemic syndrome
Other complications include, acute renal failure, thrombocytopenia and microangiopathic haemolytic anaemia

33
Q

How should e.coli 0157 associated gastroenteritis be treated?

A

Supportive only
NO antibiotics
NO anti mobility drugs e.g. loperamide or diphenoxylate, or opioids
NO NSAIDs

34
Q

What are the 5 main types of e.coli associated gastroenteritis?

A

Enterohaemorrhagic (VTEC)
Enterotoxigenic (ETEC)
enteropathogenic (EPEC)
enteroaggregative(EAEC)
enteroinvasive (EIEC)

35
Q

What can yersinia enterocolitica cause?

A

In young children = fever, abdo pain, diarrhoea +/- blood

Older children and adults = fever, pain on right abdomen

36
Q

What can listeria monocytogenes cause?

A

Serious gastroenteritis in pregnant women, newborns, immunocompromised and people >65 from unpasteurised dairy products e.g. soft cheese

37
Q

How does vibrio parahaemolyticus and plesiomomas shigelloides cause gastroenteritis?

A

Comes from raw seafood and can cause severe disease in immunocompromised. Symptoms include abdo pain, fever, nausea, vomiting, muscle aches and headaches lasting 24hours-3 days.

38
Q

What are the 5 main viruses causing viral gastroenteritis?

A

Rotavirus
Adenovirus
Norovirus
Astrovirus
Calicivirus

39
Q

How does rotavirus associated gastroenteritis present?

A

With diarrhoea, vomiting and fever (usually in children) lasting 5-7 days

40
Q

How does adenovirus associated gastroenteritis present?

A

With diahrroea, vomiting and fever in infants and young children lasting 5-12 days

41
Q

How does norovirus associated gastroenteritis present?

A

With acute vomiting, diarrhoea, fever, myalgia, headache lasting 1-2 days affecting everyone and especially rife in hospitals, nurseries, nursing homes and cruise ships

42
Q

How does entamoeba histolytica associated gastroenteritis present?

A

With water diarrhoea and then bloody diarrhoea, nausea, vomiting, tenesmus and malaise after ingesting contaminated food or water usually 15 days after exposure.

43
Q

What is a complication of entamoeba histolytica?

A

Liver abscesses

44
Q

How is entamoeba histolytica associated gastroenteritis also known?

A

Amoebic dysentery

45
Q

How is amoebic dysentery treated?

A

Always prescribe antibiotics for confirmed cases
If acute invasive or liver abscesses with metronidazole or tinidazole followed by 10 days of diloxanide furoates.
Asymptomatic with cysts in faeces = diloxanide furoate.

46
Q

How does cryptosporidosis present?

A

Watery diarrhoea, weight loss and low grade fever or severe chronic diahroea in immunocompromised which develops 2-10 days after exposure from animals, fish, reptiles or contaminated water.

47
Q

Who is treated for cryptosporidosis and how?

A

Only necessary for immunocompromised and treatment is aimed at underlying condition, and very occasionally patients are given nitazoxanide but unproven benefit

48
Q

What is giardiasis?

A

Giardia intestinalis associated gastroenteritis presenting with foul-smelling, watery diarrhoea, cramps, steatorrhoea and flatulence that has a sudden onset 1-4 weeks after exposure with contaminated water and can lead to chronic relapsing of diarrhoea

49
Q

How is giardiasis treated?

A

Metronidazole for all confirmed cases or tinidazole

50
Q

What is cholera?

A

Abrupt, ‘rice water’ stool causing significant fluid loss and hypovolemic shock 12 hours-5 days after ingestion of cholera toxin from water or food (especially shellfish)

51
Q

How is cholera treated?

A

Oral rehydration if not severe
Antibiotics for moderate to severe dehydration e.g. with tetra/doxycycline or ciprofloxacin

52
Q

What causes enteric fevers?

A

Infection with salmonella typhi causing fever, headache, malaise, anorexia, constipation/diarrhoea 6-30 days after exposure

Infection with salmonella paratyphi causing diarrhoea, splenomegaly, high fever and rose spots 1-10 days after exposure

53
Q

What is the immune response to salmonella typhi/paratyphi?

A

Engulfed by macrophages and migrate to the liver, spleen and bone marrow

54
Q

How should enteric fever be treated?

A

Immediate antibiotics - usually azithromycin - for all confirmed cases unless, multiple resistant then have fluoroquinolone or cefixime,or quinlone resistant then prescribe azithromycin or ceftriaxone

55
Q

What is the most common bacteria associated with antibiotic associated diarrhoea?

A

Clostridium difficile

56
Q

How does c. Diff associated gastroenteritis present?

A

Foul smelling, watery diarrhoea, Cramps and Low grade fever + potentially PMS, toxic megacolon or death due to toxin mediated inflammation and spores aid transmission

57
Q

What are risk factors for c. Diff associated diarrhoea?

A

Antibiotics
Age >65
Hospital stays

58
Q

How is c. Diff associated gastroenteritis diagnoses?

A

By demonstration of toxin as well as organism

59
Q

How is c.diff/antibiotic associated gastroenteritis treated?

A

Stopping current antibiotics predisposing the diarrhoea
Start on vancomycin or fidaxomicin

60
Q

What is strep gallolyticus associated with?

A

Infective endocarditis and septicaemia in elderly
Associated with colorectal cancer

61
Q

How is strep gallolyticus modelled to promote colorectal cancer?

A

1 - metabolite production by s. gallolyticus causes gallocin secretion by pre-neoplastic epithelium causing microbial imbalance which may lead to malignancy

2- high colonisation induces inflammation accelerating transformation of pre-malignant to malignant epithelium

62
Q

How does mycobacterium tuberculosis associated gastroenteritis present?

A

With abdominal pain, weight loss, anaemia , tiredness and night sweats.

63
Q

How is gastrointestinal TB treated?

A

If no CNS involvement with isoniazid, rifampicin, pyrazinamide and ethambutol for 2 months then isoniazid and rifampicin for a further 4 months

64
Q

How often does c.diff infection recur?

A

30%

Clinical Pathology (65 decks)

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