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Gastrointestinal > Cross: Inflamamtory Diarrhea > Flashcards

Cross: Inflamamtory Diarrhea Flashcards

1
Q

Causes of inflammatory D

A 
****SEESSCCY****
Shigella
EHEC
EIEC
Salmonella enterica
Salmonella enteritidis**
C. jejuni
C. difficile
Yersinia enterocolitica
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2
Q

90% of infectious D=

A

viral etiology

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3
Q

D lasting longer than 10-14 days=

A

likely from a parasite

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4
Q

acute diarrhea

A

3 or more loose stools per day lasting less than 2 weeks

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5
Q

chronic diarrhea

A

more than 4 weeks-consider HIV status

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6
Q

bugs that cause D in HIV patients

A

MAI

CMV

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7
Q

define inflammatory D

A
  • small volume
  • often bloody (dysentery)
  • WBC/RBC’s in stool
  • fever is COMMON
  • most often affects colon
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8
Q

define non-inflammatory D

A
  • large volume
  • watery
  • non-bloody
  • no cells in stool
  • afebrile
  • SMALL INTESTINE USUALLY AFFECTED
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9
Q

general characters for Shigella, E. coli, Salmonella

A 
>Gram Negative
>glucose fermenting with acid production?
>Oxidase negative
>reduce nitrates to nitrites
ALL MOTILE EXCEPT SHIGELLA
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10
Q

flagellar antigens

A

H antigen

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11
Q

polysaccharide side chain on LPS

A

O antigen

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12
Q

Gram negative, NON-motile, NON-lactose fermenting, DOES Not PRODUCE H2S

A

Shigella

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13
Q

Strain of Shigella most commonly affecting US-school aged/day care children

A

Shigella sonnei-70% cases

DAYCARE CENTERS migrant workers, nursing homes, traveler to developing countries,

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14
Q

most common shigella strains worldwide

A
  1. Shigella dysenteriae

2. Shigella flexneri

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15
Q

how is shigella transmitted

A

fecal oral route-very low ID

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16
Q

shigella pathogenesis

EIEC has a similar mechanism

A

> taken up by M cells (resistant to gastric acid)
escape into LP-taken up by macs-> cause apoptosis
HOST INFLAMMATORY RESPONSE KILLE THE CELL IN WHICH IT IS MUTLIPLYING-ALLOWING IT TO ESCAPE
SPREADS FROM CELL TO CELL VIA MEMBRANE BOUND PROTRUSIONS -FORMINS-DEPENDENT ON HOST CELLULAR ACTIN POLYMERIZATION-LYSES MEMBRANES THAT SURROUNDS IT AND NOW IS FREE IN ADJACENT CELL

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17
Q

complications from Shigellosis

A
  1. reiter’s syndrome

2. HUS- from shiga toxin (AB toxin) more common with S. dysenteriae

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18
Q

TX for Shigellosis

A

Ceftriaxone
Ciprofloxacin
Azithromycin
*shortens course and reduces duration of organism shedding in tools

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19
Q

this bug can cause inflammatory and non-inflammatory diarrhea

A

E. coli

5 strains we are discussing here

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20
Q

how does shiga toxin work>

A

cleaves a base on the 28s of 60S subunit in Ribosomal subunit thus inhibiting protein synthesis

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21
Q

shiga toxin seen in

A

Shigella dysenteria
EHEC (Shiga toxigenic e coli) which include O157:H7
and O104: H4
*these are really “SHIGA-TOXIN-LIKE”

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22
Q

cannot ferment sorbitol-colonies white on culture

DISTINGUISHING FEATURE

A

EHEC-aka STEC

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23
Q

SOURCE OF EHEC

A

INADEQUATELY COOKED MEAT (HAMBURGERS)-CONTAM VEGGIES AND MIK-ALSO HUMAN-TO HUMAN

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24
Q

CAUSES HEMORRHAGIC COLITIS- HOSPITAL STAY IN 50%-SHIG TOXIUN LIKE S. DYSENTERIAE

A

EHEC

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25
Q

ehec Is grouped into

A

O157:H7-like and

non O157: H7

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26
Q

locus of enterocyte effacement (LEE)

A

PAI within EHEC that contains a TYPE III secretion system-aids in attachment and effacement of the bug onto colonic mucosa via a pedestal formation and delivery of the e coli receptor to the host cell

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27
Q

responsible for the diarrhea in EHEC

A

LEE pathogenicity island

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28
Q

little fever, acute onset cramps and WATERY D-becomes bloody (hemorrhagic colitis) within 24 hours-lasts up to 8 days

A

EHEC

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29
Q

EHEC strain more likely to cause outbreaks, dysentery, HUS, ischemic colitis

A

O157:H7

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30
Q

which bugs use LEE for entry

A

EHEC and EPEC

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31
Q

feared complication of EHEC and Shigellosis (less common)

5-10 days after diarrhea

A 
HUS from SHIGA TOXIN IN BLOOD STREAM
90% of cases in children
but only complicated 9% of EHEC cases
5% mortality rate
50% require dialysis-most regain function
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32
Q

main cause of AKI in children

A

HUS following EHEC infection

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33
Q

clinical features of HUS

A 
microangiopathic hemolytic anemia and thombocytopenia
AKI requiring dialysis in half
5-10 days after D
SHISTOCYTES ON PBSMEAR
neuro symptoms-seizure/somnolence
34
Q

Dx of EHEC

A
  1. Sorbitol MacCOnkey agar-white colonies

2. Elisa for Shiga toxin A and B

35
Q

Tx for EHEC

A

SUPPORTIVE care and monitoring
>ab’s are contraindicated-would spread toxin through lysis of cells-increased risk of HUS
>anti-diarrheals are contraindicated

36
Q

e. coli strain similar to Shigella sonnei causing a similar disease

A

EIEC
food-water
person-person
transmission

37
Q

movement from one cell to another for EIEC-

A

moves similar to Shigella sonnei-with actin polymers
replicates intracellularly and extends into adjacent intestinal cells

“formins”–not sure if it is exactlyt the same but cross lumped these two together by their means of pathogensis

38
Q

doe EIEC mae toxins

A

no-in this way it is not like S. dystenteria

39
Q

h2S producing
non-lactose-fermenting
gram negative BACillUS

A

salmonella

40
Q

causative agents of TYPHOID fever

A

> Salmonella enterica subtype Typhimurium

>salmonella parathypi

41
Q

causative agent of salmonellosis

A

NONTYPHOID salmonella
Salmonella enteritidis
*common cause fo food poisoning

42
Q

does S enterica or paratyphi cause gastroenteritis?

A

HELL NAW

43
Q

sources of Salmonella

A

chicken, eggs, dairy
turtles lizards other reptiles
human-human

44
Q

taken up by M cells-TYPE III secretion system-bacterial prots allow for growth withing ENDOSOMES-invade LP-host response kills macrophages as well

A

Salmonella enteriditis

45
Q

5% will develop invasive disease: bacteremia, endovascular infections, endocarditis, osteomyelitis. Predilection for aortic plaques, bone prostheses

A

salmonellosis

S. enteriditis

46
Q

reactive arthritis seen with which bugs

A

Salmonella enteriditis

Shigellosis

47
Q

Dx of salmonella

A

stool culture

48
Q

tx of salmonella

A

not required for healthy ppl-RESISTANCE IS AN ISSUE

> only tx those at risk for disseinated infection
KNOWN OR SUSPECTED ATHEROSCLEROTIC PLAQUES
IMMUNOCOMPROMISED-HIV SICKLE CELL

49
Q

TX OF SALMONELLA WHEN INDICATED

A

FLOROQUINOLONES

50
Q

TYPHOID FEVER CAUSED BY____AND PATHOGENSESIS

resides in submucosa-peyer’s patch hyperplasia

A

SALMONELLA-ENTERICA SUBTYPE THPHIMURIUM
-taken up by M cells-gets in RES and LN’s-spreads to blood (sepsis can occur)-HYPERTROPHY OF PEYERS PATCHES–necrosis follows-occasionally perforation

51
Q

clinical presentation of typhoid fever

A

1st week-fever chills bactermia
2nd week-abdominal pain and rose spots
3rd week- hepatosplenomegaly (mainly spleen)-GI bleed, perforation-2ndary bactermia

52
Q

Tx of typhoid fever-Salmonella enterica typhimurium

A

Ceftriaxone, Azithromycin, or cipro
(Possibly resistance to florquinolone)
VACCINE AVAILABLE

53
Q

most common bacterial pathogen in the developed world

A

Campylobacter jejuni

54
Q

thin spiral shaped GNR

A

c. jejuni

55
Q

most important cause of traveller’s diarrhea

A

C. jejuni

-ETEC is important too

56
Q

Unpast milk, improper chicken, contam. water

A

c jejuni

57
Q

reservoir for c jejuni

A 
sheep
cattle
chicken
wild birds
dogs
58
Q

tx of c jejuni

A

only for those w/ severe or at risk of severe dz
-Azithromycin or Cipro
(floro resistance on the rise)

59
Q

clinical course of C jejuni

A 
1 week incubation
3-7 day course
10 bm's per day 
fever
watery/bloody in 15%
dx=stool culture
60
Q

MOA for GBS

A

Guillain Barre Syndrome

-molec mimicry, antibodies to LPS cross-react with peripheral and central gangliosides

61
Q

complications for c jejuni

A

> GBS
Reactive arthritis (along with shigella and salmonella enteriditis, yersinia)
Erythema nodosa

62
Q

gram negative coccobacillus with bi-polar staining

A

Yersinia enterocolitica

63
Q

pork, water raw milk, contaminated water, pet feces

A

yersinia enterocolitica

64
Q

Yersinia clinical course

A

MIMICS APPENDICITIS
-involves illeum, appendix, right colon
-multiplies in lymph tissue=Peyer’s patch hyperplasia and LN hyperplasia
N/V/F/D-EN, Pharyngitis, arthralgia

65
Q

right sided abdominal pain

A

yersinia enterocolitica

66
Q

how to tell yersinia infection form appendicitis

A

look for
pharyngitis
arthralgia
erythema nodosum

67
Q

Tx/DX of yersinia

A

stool culture

most cases dont need tx

68
Q

anaerobic spore forming GPR (transmitted via fecal oral route)

A

Clostridium difficile

69
Q

important intermediaries of C diff

A

hospital workers hands

70
Q

most common cause of AB associated dirrhea

A

c diff

71
Q

ab’s associated with c diff diarrhea

A

peniccillin, cephalosporins, tetracycline, ampicillin

72
Q

most common nosocomial infection, and cause of nosocomial diarrhea

A

c difficile

73
Q

C diff pathogenesis

A

EXOTOXINS A AND B
THIS IS NOT AN A/B TOXIN!!!!!

ENTEROTOXIN-TOXIN A
CYTOTOXIN- TOXIN B

  • EACH WITH DIFFERENT FUNCTIONS
  • NOT AN A/B TOXIN
74
Q

C DIFF PATHOGENESIS

ENTEROTOXIN A

A

ENTEROTOXIN (TOXIN A)–> DISRUPTS COLONIC MUCOSAL CELL ADHERENCE TO BASEMENT MEMBRANE-DAMAGES VILLIOUS TIPS-LEADS TO FLUID SECRETION

75
Q

C DIFF PATHOGENESIS

CYTOTOXIN -TOXIN B

A

CAUSES DEOLYMERIZATION OF ACTIN -LOSS OF CYTOSKELETAL INTEGRITY-APOPTOSIS AND DEATH OF ENTEROCYTES

76
Q

TOXIN A AND B (A>B) BOTH DO WHAT

A

STIMULATE MONOCYTES AND MAC -RELEASE IL8-> TISSUE INFILTRATIN WITH PMN’S

-BOTH DISRUPT TIGHT JUNCTIONS OF EPITHELIA

77
Q

SECRETION-DAMAGE TO VLIIOUS TIPS-BASEMENT MEMBRANE DETTACHMENT

A

ENTEROTOXIN-TOXIN A

78
Q

DEPOLYMERIZATION OF ACTIN-APOPTOSIS AND DEATH OF ENTEROCYTES

A

CYTOTOXIN-TOXIN B

79
Q

CLINICAL FEATURE OF C DIFF

“CDAD w/ colitis”

A
  • *WATERY DIRRHEA (10-15/DAY)-MAINLY
  • -PSEUDOMEMBRANOUS COLITIS-
  • fulminant colitisSEVERE (pain distention, fever hypovolemia)
  • toxic megacolon (>7cm dilated with severe systemic toxicity)
80
Q

name the hypervirulent strain of Cdiffand the treatment

A

NAP-1/027

fidaxomicin

81
Q

gold standard for dx of c diff

A

cell culture cytotoxicity assay

stool + monolayer of cultured cells-if cytotoxic

Gastrointestinal (9 decks)

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