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Gastroenteritis Flashcards

1
Q

what are 3 crucially important pathogens?

A

1) campylobacter
2) salmonella
3) E. coli 0157

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2
Q

what are 6 GI infection risk factors?

A

1) malnutrition (micro-nutrient) deficiency
2) closed/semi-closed communities
3) exposure to contaminated food/water/travel
4) winter congregating/summer floods
5) age<5, not breastfeeding
6) older age

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3
Q

what are 4 other risk factors?

A

1) acid suppression
- yersinia enterocolitica, helicobacter pylori tolerant of acid
- C. difficile more common with acid suppression
- Vibrio cholera, non typical salmonella, campylobacter, E. coli

2) immuno-suppression
- salmonella, campylobacter, shigella shed for longer
- other organisms that are uncommon in immune competent

3) micro-biome

4) genetics
- IL8 promoter variant & servere C. difficile
- O blood group& vibrio cholera

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4
Q

what are 6 bacterial factors involved in GI infections?

A

1) adherence/attached to GI mucosa
2) cellular invasion
3) production of exotoxins
4) changes in epithelial cell physiology
5) loss of brush border digestive enzymes, and/or cell death
6) increased intestinal motility, next fluid secretion, influx of inflammatory cells, and/or intestinal haemorrhage

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5
Q

describe innocuous size that makes picking up GI infections likely.

A
  • low infectious doses make spread easier

- pH affects required dose

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6
Q

what is diarrhoea?

A

= >3 unformed stools/day
= no the cause
- exclude laxative use/abuse & use of drugs/stimulants

  • departure from normal bowel habits
  • use Bristol stool char
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7
Q

what is gastro-enteritis?

A

= inflammation of intestines, particularly colon, causing diarrhoea, associated with blood and mucosa

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8
Q

what are 2 examples of bacteria that could cause gastro-enteritis?

A
  • shigella

- campylobacter

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9
Q

what systemic things is gastro-enteritis associated with?

A
  • fever
  • abdominal pain
  • rectal tenesmus (sense of incomplete defaeceation)
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10
Q

describe the duration of gastro-enteritis?

A

acute duration < 2 weeks

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11
Q

if gastroenteritis affects the large bowel describe the volume affected?

A

smaller volume

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12
Q

what can mimic appendicitis and why?

A

= yersinia enterocolitica

- as it may invade mesenteric nodes

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13
Q

what 4 things does bacteria need to multiply?

A
  • Time
  • temperature
  • food source
  • moisture
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14
Q

what can survive adverse conditions?

A

= spores

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15
Q

what happens in the kitchen that promotes bacteria growth?

A
  • cross contamination of raw & cooked food
  • preparation food too far in advance
  • inadequate heating & cooling
  • contaminated environment & equipment
  • poor personal hygiene
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16
Q

what is gastroenteritis caused by?

A

= eating food contaminated with micro-organisms, toxins, poisons

e. g. bacteria, viruses, parasites
- invasion of tissue +/- toxin production

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17
Q

what effect does cholera have on volume of diarrhoea?

A

= large volume of diarrhoea

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18
Q

describe the history most commonly associated with gastroenteritis?

A
  • diarrhoea, blood, mucus, time course
  • other GI symptoms
  • travel, contacts = human and animal
  • food history = storage, re-heating, washing
  • age of patients
  • co-morbitidites
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19
Q

describe what infections would be common with foreign travel, recent camping, recent antibiotics, daycare exposure, exposure to raw seafood, anal sex, HIV positive status and outbreaks.

A

Foreign travel

  • travellers diarrhoea = enterotoxigenic E. coli
  • Southeast Asia = vibrio species
  • South America, Africa, Asia = rotavirus

Recent camping
= giardia
= aeromonas
= cryptosporidium

Recent antibiotics
= C. difficile

Daycare exposure
= rotavirus

Exposure to raw seafood
= non-cholera vibrio

Anal sex
= shigella
= campylobacter
= salmonella

HIV positive statua
= mycobacterium avium-intracellular complex, mixrosporidia, cytomegalovirus, giarida

Outbreaks

  • cruise ships = noro
  • contaminated water, food = salmonella, E. coli, campylobacter
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20
Q

what 2 bacterias have a short incubation time of 1-6hours?

A

1) bacillus cereus (gram + bacillus)
- starchy foods
- heat resistance spores
- profuse vomiting
- reheating rice

2) staphylococcus aureus (Gram + coccus)
- performed toxin in food, rapid absorption
- acts on vomiting centre in bran
- foods left in room tempt
- milk/meat/fish

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21
Q

what do all stooges get tested for?

A 
= salmonella 
= shigella
= campylobacter
= E. coli 0157
= cryptosporidium

All > 4years stools get;
= C. difficile

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22
Q

what are the 4 groups associated with Shigella sp?

A

group A
= S. dysenteriae

group B
= S. flexneri

group C
= S. boydii

group D
= S. sonnei

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23
Q

what does shiga toxins do?

A
  • binds to receptors on renal cells, RBC and others
  • inhibiting proteins synthesis
  • causes cell death
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24
Q

what toxin can produce E. coli?

A

= shiga-toxin producing E. coli

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25
Q

what symptom is associated with E. coli 0157 infections?

A

= bloody diarrhoea

= bloody per rectum

26
Q

describe how one would acquire E. coli 0157?

A
  • very low infectious dose
  • food (raw milk, water)
  • person to person
  • animal contact

= children and elderly at risk of complications

27
Q

describe the incubation time for E. coli 0157?

A

= 1-14 days

28
Q

what can E. coli 0157 produce?

A

= verotohxin (VTEC)

29
Q

what is HUS?

A

= haemolytic uraemic syndrome (HUS)

30
Q

what is HUS associated with?

A
  • abdominal pain
  • fever
  • pallor
  • petechiae
  • oliguria
  • bloody diarrhoea
31
Q

describe the cell count that would be found in HUS?

A
  • high white cells
  • low platelets
  • low HB
  • red cell fragments
  • LDH > 1.5
  • may develop after diarrhoea stopped
32
Q

how would you investigate HUS?

A
  • send stool cultures samples

- send U&E, FBC, film, LFT, clothing, urine, dehydrogenase

33
Q

Gastroenteritis 2

A

Gastroenteritis 2

34
Q

what are 4 other E. coli pathotypes?

A

1) enterotoxigenic (ETEC)
2) enteropathogenic (EPEC)
3) enteroinvasive (ELEC)
4) enteroaggregative (EAIC)

35
Q

describe enterotoxigenic (ETEC).

A
  • produces heat labile and heat stable toxin
  • heat stable toxin similar to choler and yersinia toxins
  • travel related
36
Q

describe enteropathogenic?

A 
- attaching and affecting lesions 
= no toxins, not invasive 
- synthesises, secretes &amp; inserts its own receptor into cell membranes
- non breastfed children
- can be asymptomatic
37
Q

describe enteroinnvasive?

A

= watery diarrhoea, rare dysentry

  • demonstrates invasion
  • sereny test
38
Q

describe entero-aggregaive?

A
  • travellers diarrhoea

- cryogenic, secretogenic, pro-inflammatory

39
Q 
True or false. 
All diarrhoea (blood or not) is infectious?
A

False.

40
Q

describe the incubation times for campylobacter?

A
  • 16-48hours
41
Q

describe how campylobacter is spread?

A
  • spread sporadically (rarely outbreaks)
  • food:poultry
  • small pathogen number
  • food, hygiene (raw poultry especially)
  • macrolide
  • less likely to spread person to person
  • invasive
  • pain, blood, fever

= most common

42
Q

what are some campylobacter human pathogenic strains (enteric)

A
  • C jejunisubspeciesjejuni
  • C jejunisubspeciesdoylei
  • Campylobacter coli
  • Campylobacter upsaliensis
  • Campylobacter lari
  • C fetussubspeciesfetus
  • Campylobacter hyointestinalis
  • Campylobacter concisus
43
Q

describe the incubation time for salmonella enteritidis?

A

= 12-48hours

44
Q

how is salmonella enteritidis spread?

A
  • food: poultry, meat, raw egg
  • animal gut, multiplies in food
  • toxin and invasion
  • D&V, blood, fever
45
Q

describe the serotyping of salmonella?

A
  • > 1500 different types: group A to Z based on antigen of body (O antigen)

= a serotype helps pinpoint source of infection

= groups B, C and D are most commonly locally

46
Q

describe the incubation time for listeria monocytogenes?

A

= 9-48hours

47
Q

describe the incubation time for listeria monocytogenes?

A

= 9-48hours

48
Q

describe the symptoms of listeria monocytogenes?

A
  • fever
  • muscle aches
  • diarrhoea

= pregnant women may have mild symptoms

49
Q

how would one acquire listeria monocytogenes?

A
  • unpasteurised milk products, deli counter
50
Q

describe the invasiveness of listeria monocytogenes?

A
  • 2-6weeks
  • immunosuppressed
  • aged > 50
  • pregnant
  • meningitis/bacteraemia
51
Q

what type of bacteria is listeria monocytogenes?

A

gram + rod

52
Q

how is listeria monocytogenes spread?

A
  • food borne transmission
  • mother to child
  • rarely other
53
Q

describe monocytosis in listeria monocytogenes?

A
  • extract of cell membrane causes monocytosis in rabies, rarely in humans
  • but 67% cases of listeria monocytogenes have neutrophils
54
Q

what are 2 important viruses in viral gastroenteritis?

A
  • rotavirus

- noravirus

55
Q

describe rotavirus.

A

= most common cause in kids <3years

  • all kids get it before 5
  • person to person, faecal oral spread (direct & indirect)
  • usually in winter
  • moderate fever
  • vomiting
  • diarrhoea
  • not bloody
  • selt limiting
  • lasts a week
56
Q

describe the infectious dose of rotavirus?

A

= low infectious dose
- 100-1000particles
= faecal-oral

  • survives in environment
  • billions shed in faeces when diarrhoea
  • affects absorption & secretion in bowel
57
Q

what may children with rotavirus have?

A

= post infection malabsorptions

- leading to more diarrhoea

58
Q

what is the key to managing rotavirus?

A

= hydration

59
Q

describe the rotavirus vaccine?

A
  • oral
  • live attenuated
  • excreted in faeces
  • 2 doses = 2 and 3 months
60
Q

describe norovirus?

A

= winter vomiting disease

  • affects all ages (HIGHLY infectious)
    = 5 billions viruses per gram of faeces
  • faecal-oral/droplet routes of spread
  • person to person
  • environmental survival on fomites for days-weeks
61
Q

describe diagnosis and treatment of norovirus?

A

Diagnosis
= PCR on stool, takes 6hours

treatment
= self-limiting (unpleasant)
- hydration is key

62
Q

describe diagnosis and treatment of norovirus?

A

Diagnosis
= PCR on stool, takes 6hours

treatment
= self-limiting (unpleasant)
- hydration is key

GI (43 decks)

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