diarrhea cases

Question 1

non inflammatory diarrhea

leftover potato salad

Answer 1

S. aureus,

1-6 hr onset, N/V, fever,

Question 2

non inflammatory diarrhea

leftover chinese food

Answer 2

Bacillus cereus
pre-formed in rice-reheated
short “emetic” syndrome: 1-6 hrs,

Question 3

non-inflamm. diarrhea

buffet

Answer 3

Clostridium perfringens

short incubation: 8-16 hrs, toxin in vivo,

Question 4

Vibrio cholera

Answer 4

incub. 16-72 hrs
shellfisch, profuse water diarrhea, rice water
lasts 5-12 days
abx: Fqs tetra, doxy: shorten duration, dec. shedding

Question 5

ETEC

Answer 5

72-96 hrs

tropics, traveller’s diarrhea

Question 6

non-inflamm., secretory
cruise ship
nursing homes

Answer 6

Norovirus
shellfish, con tam water, aerated vomit
v. contagious
onset 24-48 hrs, last 24-48 hrs
ha, myalgias

Question 7

rotavirus

Answer 7

pediatric
winter mos (yr round in tropics)
sev. dehyration, up to 10 days

Question 8

Adenovirus

Answer 8

pediatric diarrhea

Question 9

Astrovirus

Answer 9

day care kids

Question 10

inflamm.
70 yo, confused
oysters

Answer 10

Vibrio parahemolyticus
supportive care, admit for IV fluids
incub. 24 hrs
Japan, gulf coast
undercooked shellfish
explosive
last 3 days
no abx

Question 11

3 yo old boy from day care to Hawaii
bloody diarrhea
spread to fam

Answer 11

Shigella
low infectious dose
person-person
milk, ice cream
biphasic: watery, then bloody
"Bacillary dysentery"
1 wk, self-limited
tx to dec. communicability: FQs, TMP-SMX, amp
HUS, reac. arthritis

Question 12

bloody diarrhea 1 day (acute)
fever, prev. doing well
2-3 wks later, leg weakness

Answer 12

Campylobacter jejuni
inc. 1-7 days
prodrome, tenesmus, 25% relapse
macrolides, quinolones
undercooked chicken, hikers, travelers
2-3 wks later, leg weakness: Guillain-Barre
also reactive arthritis (6-8 wks)

Question 13

1 wk ago pneumonia
fever 103, diarrhea
elev. WBC (32,000)
hypotnsive, confused, bloody

Answer 13

C. diff
older pts
complications: toxic megacolon, pseudomembranous colitis
abx: clinda, FQs-both may cause!
tx w.: vanco, metro, fidaxomycin, fecal microbiota transplant
contact precautions
use PCR to dx

Question 14

3 yo bloody diarrhea
fever 102, watery @ first
fresh apple juice
elev. WBC, low HCT, low platelet
Schistocytes on peripheral sm
elev. CR

Answer 14

EHEC: enterohemorrhagec E. coli
june-sept undercooked food, unpast. juice/milk, sprouts, lettuce
incubation 3-4 ds
Shiga-like toxin
tx: TMP-SMX
HUS (75-90% of HUS cases are EHEC)
tx may inc. risk

Question 15

Mexico
fever, chills
frozen margarita
WBC in stools
\+ for blood (but not frank)

Answer 15

Salmonella
achlorhydria, SCD pts
eggs, con tam. dairy, poultry
pets: lizards, turtles
tx: does not dec., may inc. risk for relapse, only tx if bacteremic, IC, infants

Question 16

from India, had typhoid fever

acute drop

Answer 16

perforation and secondary peritonitis
enteric fever
travellers
goes to lymphatic tissue: Peyer’s patches

Question 17

Yersinia enterocolitica

Answer 17

“cold” bug

kids

Question 18

EIEC

Answer 18

inflamm and destr intenstinal mucosal

Question 19

loose stools 3 wks

wl, smelly,

Answer 19

Giardia
bloating, malabsortion, frothy
waterborne, p-p, hikers, daycares, homosexuals
tx: metro

Question 20

Cryptosporidium parvum

Answer 20

low inoculum
HIV: bulky, >30 d
no WBC
reactive arthritis
tx: nitazo, azithro

Question 21

typical for protozoa

Answer 21

more chronic, less systemic

Question 22

entamoeba histolytica

Answer 22

may be more acute
imported
bloody
fulm. colitis
liver abscess, brain, lung abcess