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Gastroenteritis Flashcards

1
Q

Which gastroenteritis bugs have a 1-6 hr incubation?

A

Staph aureus and bacillus cereus

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2
Q

Which GI bugs have a 8-14 hr incubation?

A

Clostridium perfringens

Bacillus cereus

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3
Q

Which bugs have a 16 hour incubation or longer?

A
  1. cholera
  2. vibrio parahemolyticus
  3. ETEC
  4. Salmonella
  5. Shigella
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4
Q

Common food to get ETEC

A

salad

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5
Q

Easy way to get vibrio parahemolyticus

A

oysters/shellfish

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6
Q

Easy way to get C perfringens:

A

beef/poultry

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7
Q

Easy way to get shigella

A

Potato/egg salad,

Raw veggies

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8
Q

What population is at greater risk for shigella?

A

MSM and daycare populations

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9
Q

What can cause gastroenteritis in a pregnant woman?

A

Listeria

HepE

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10
Q

What does non-inflammatory diarrhea (toxin mediated) look like?

A

Affects the proximal small bowel

Watery stool with no WBCs

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11
Q

What does inflammatory diarrhea look like?

A

Affects the colon
bloody/mucoid appearance
Fecal WBC is elevated

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12
Q

What are some bugs that cause inflammatory diarrhea?

A

Shigella, salmonella
EHEC/EIEC (NOT ETEC)
C difficile
Campylobacter

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13
Q

What causes penetrating diarrhea?

A

Salmonella typhi

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14
Q

What is the definition of diarrhea?

A

3 loose stools in a 24 hr period

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15
Q

At what point is diarrhea considered “persistent”?

A

14 days

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16
Q

At what point is diarrhea considered chronic?

A

30 days

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17
Q

When would you want to work up diarrhea?

A
  1. bloody
  2. hypovolemia
  3. Small volume stool w/ blood/mucus
  4. Immunocompromised/pregnant (listeria)
  5. High fever, duration > 48 hrs
  6. Recent antibiotic use
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18
Q

What can you do to test whether an infectious agent is causing the diarrhea?

A
  1. Fecal WBC
  2. Lactoferrin
  3. Stool culture (salmonella, shigella, campylobacter, EHEC)
  4. Ova and parasite screen for crypto, giardia, amoeba
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19
Q

How does norovirus cause disease?

A

Damages the brush border. Causes NON bloody diarrhea

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20
Q

How is rotavirus released into the body?

A

Activatino by proteolysis releases subviral particles

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21
Q

How do you diagnose norovirus?

A

PCR

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22
Q

How do you diagnose rotavirus?

A

Rapid antigen detection

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23
Q

How do you treat noro/rotavirus?

A

SUPPORTIVE

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24
Q

How does shigella cause disease

A

It invades the colonic epithelial cell and causes ulcerations

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25
What is a serious complication of shigella?
Shiga toxin can cause hemolytic anemia
26
How does s. typhi cause disease
1. Penetrates bowel mucosa - ->lymphatics - ->bile - ->GI
27
What does S typhi look like, clinically?
headache/fever/malaise Rose spots T-pulse dissociation Positive blood cultures
28
How do you treat s typhi?
Ampicillin Tmp/SMX Cipro
29
HOw do you treat a regular salmonella infection?
FLUIDS-->if immunocompromised or very severe, then consider cipro/Bactrim
30
What complication does C diff cause?
pseudomembranous colitis
31
How do you treat C diff?
Metronidazole. Vancomycin if severe
32
What type of organism is yersinia enterocolina?
Intracellular.
33
How does yersinia present?
Appendicitis-like sx with diarrhea and fever
34
How do you treat yersinia?
Tetracycline, TMP, SMX
35
How does vibrio parahemolyticus present?
1. Explosive, watery diarrhea with low grade fever. - ->dx thru stool culture - ->tx is supportive
36
How does cholera cause disease?
Toxin increases adenylate cyclase.
37
How does cholera get diagnosed?
rice water stool with NO FEVER | -->use stool culture to diagnose
38
How do you treat cholera?
IV/PO fluid replacement | Tetracycline
39
How does listeria cause disease?
Intracellular pathogen. Infects macrophages
40
Who is at risk for listeria?
Pregnant Immunocompromised very young very old
41
How does listeria present?
Fever, myalgias bacteremia meningitis
42
How do you diagnose and treat listeria?
Dx: blood/CSF Tx: Ampicillin
43
What are common causes of acute endocarditis?
S aureus S pneumo GAS
44
What are common causes of subacute endocarditis?
Viridans strep | CoNStaph
45
What are the differences between subacute and acute endocarditis?
Subacute ONLY occurs on abnormal valves - -Onset occurs over months - -Caused by less virulent organisms
46
What are the predisposing factors for endocarditis?
1. IV drug use 2. Mitral valve prolapse 3. Degenerative valve disease 4. rheumatic heart disease 5. Poor dental hygiene 6. hemodialysis
47
What would you worry about if you saw an S bovis endocarditis?
Colon cancer/lesion
48
What kind of endocarditis would you see in men with bladder outlet obstruction?
enterococci
49
Suppose you have culture negative endocarditis. What kind of organism do you have? What might you suspect in recent history of pt?
Fastidious organism - -Caused by recent antibiotic tx - -Try growing for a longer period or on a richer medium
50
What are the causes of culture-negative endocarditis?
HACEK - Hflu - actinobacillus (not bacter) - cardiobacterium - eikenella - kingella
51
What is the typical presentation of bacterial endocarditis?
``` Fever Roth's spots Osler's nodes Murmur Janeway lesions Anemia Nail hemorrhage (splinter hemorrhages) Emboli ```
52
What is unique about IV drug use endocarditis?
- polymicrobial (S aureus also common) - Right sided (tricuspid) - Pleuritic chest pain common - -Pulmonary emboli rather than cerebrovascular emboli
53
Why would you worry about giving nafcillin?
Can cause acute interstitial nephritis
54
What are the indications for valve replacement surgery?
1. Bacteremia that persists beyond 5 days 2. heart block 3. CHF 4. Fungi, pseudomonas, 5. Recent emboli 6. Vegetations over 1 cm
55
If infection is < 12 mos after placement of the prosthetic valve, it's usually caused by:
Coagualase negative staph
56
If infection occurs after 12 months after a prosthetic valve is placed, it's usually caused by:
STREP
57
If a patient gets an infection of a prosthetic valve, what would make you think it was hospital acquired?
If it occurred within 2 months of surgery
58
Dx of endocarditis?
Blood cultures--3 different sites - -If SBE: cultures are extracted over hours - -If ABE: taken over several minutes Echocardiography Duke criteria
59
Describe the differences between a transthoracic and transesophageal echo
Transthoracic: rapid, high specificity - -Low sensitivity - -Body habitus dependent Transesophageal: MUCH higher sensitivity than a transthoracic echo (duh, you're closer to the heart!) --Better image, but more expensive/invasive
60
What are the major duke criteria?
1. New murmur 2. Blood cultures positive with a typical organism 3. Echo is positive for mass or abscess
61
What are the minor duke criteria?
1. High predisposition for Endocarditis (IV, history) 2. Fever 3. Vascular findings (CHF) 4. Immuno findings (Osler's nodes or roth spots) 5. Positive blood cultures with an atypical organism or not consistently positive
62
What would make you think definite endocarditis with the duke crieria?
2 major 1 major + 3 minor 5 minor
63
How do you treat endocarditis?
If ABE: Start tx as soon as you've obtained the blood cultures If SBE: Delay tx until culture results have returned Treat until pt has become afebrile and there have been negative repeat blood cultures
64
If HACEK organism: what do you treat with?
Ceftriaxone for 4 weeks
65
If Enterococcus, what do you treat with?
Penicillin + gentamicin
66
If Strep pneumo, what do you treat with?
Gentamicin for 2 weeks, then penicillin for 4
67
If viridans strep, what do you treat with?
Penicillin G
68
How do you treat if a patient has a prosthetic valve?
Gentamicin for 2 weeks if sensitive strep. Treat for 4-6 weeks of gentamicin if resistant strep Add rifampin for MSSA, MRSA< and coag - staph IN ADDITION TO THE GENTAMICIN regimen
69
Who should you give Abx prophylaxis to? In what scenarios?
1. pts with underlying valve dz 2. procedures with a high risk of bacteremia --Dental procedures and surgery
70
Who are the highest risk pts with endocarditis?
1. Pt with a history of endocarditis 2. Prosthetic valves 3. Cyanotic congenital heart disease
71
Who are moderate risk pts with endocarditis?
1. Cardiac malformations 2. Valvular dysfunction 3. Hypertrophic cardiomyopathy 4. Mitral valve prolapse with regurgitation

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