Enterobacteriaceae II, Salmonella, Enterobacteriaceae resistance

Question 1

Identification/Diagnosis of Salmonella (typhoidal and non-typhoidal)

Answer 1

Gram (-ve), motile rods, that Do NOT ferment Lactose
–> PNF via freshly passed stool

Question 2

Transmission of Typhoidal/ NTS Salmonellase

Answer 2

Human restricted, Ingestion of foecally contaminated water or food

• Gallbladder –> site of chronic Carriage

Question 3

Clinical syndromes attributed to Complicated Typhoidal Salmonellae

Answer 3

1) Intestinal Haemorrhage
2) Intestinal Perforation
3) Neurologic- encephalopathy, meningitis, Guillain-Barre S. , Transverse myelitis
4) Osteomyelitis, liver & splenic abscesses

Question 4

Clinical syndromes attributed to Uncomplicated Typhoidal Salmonellae

Answer 4

1) ENTERIC FEVER w/o localized symptoms
2) Myalgia
3) CONSTIPATION
4) abdominal cramps
5) Rose spots
5) Hepatosplenomegaly - elevated liver enzymes

Question 5

Treatment of Typhoidal Salmonellae

Answer 5

S.typhi vaccination:
1) Vivotif –> avoid in immunosuppressed
2) Typhim –> safe in immunosuppressed

Question 6

What is Chronic carriage of NTS & typhoidal Salmonellae

Answer 6

Asymptomatic shedding of S.typhi and S.paratyphi for >1yr in stools or urine
* They both establish chronic carriage in the Gallbaldder

Question 7

Transmission of NTS

Answer 7

Foodborne, animal faeces
Transmission: Eggs, undercooked meat, contaminated water

Question 8

Treatment of NTS ?

Answer 8

Do no treat w/ abx –> Antibiotics prolong carriage
* Treat if only high risk for complications

Question 9

Clinical syndromes attributed to Uncomplicated NTS

Answer 9

SELF-LIMITED
1) Gastroenteritis
–> self-limited gastroenteritis, Within 48hrs, watery diarrhea, nausea, vomiting, fever & abdominal cramps that lasts 3-7d

Question 10

Clinical syndromes attributed to Complicated NTS

Answer 10

1) Bacteraemia: propensity for vascular sites
2) localised infections
–> endocarditis, arteritis, meningitis, brain abscess, chronic osteomyelitis, reactive arthritis, splenic abscesses (sickle cell disease)

Question 11

Which 2 are the most important resistance phenotypes of Enterobacteriaceae

Answer 11

1) ESBL- Extended Spectrum β-Lactamases
2) CRE - Carbapenem Resistant Enterobacteriaceae

Question 12

What’s the treatment of choice for ESBL-producing Gram-negative Bacilli

Answer 12

Carbapenem

Question 13

What clinical syndrome is this ? Caused by what pathogen ?

Answer 13

Enteric fever Rose spots caused by Typhoidal Salmonella

Question 14

CRE- Carbapenem resistant Enterobarcteriaceae is an anti-microbial resistant and HA infection
What exactly is it resistant/ sensitive to?

Answer 14

Resistant to :
1) Carbapenem
2) β-lactamase inhibitors

Sensitive :
1) Colistin

Question 15

What precautions can be done to prevent transmission of nosocomial pathogens?

Answer 15

Proper hand washing