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MI Internal Medicine and Infectious Disease > Gastrointestinal Infections > Flashcards

Gastrointestinal Infections Flashcards

1
Q

Most common viral cause of foodborne illness

A

Norovirus 5.4 million/year 26% foodborne

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2
Q

Viral causes of foodborne illness

A
  1. Norovirus (5.4/1.4M)
  2. Rotavirus (15K/<1)
  3. Astrovirus (15K<1)
  4. Sapovirus (15K<1)
  5. Hepatitis A virus (1.5K/109/0.31/0.02)
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3
Q

Most common bacterial causes of foodborne illness

A
  1. Salmonella (1M/0.27)
  2. Clostridium perfringens (965K)
  3. Campylobacter (845/675K/0.17)
  4. Staph aureus (241K/0.06)
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4
Q

Most common parasitic causes of foodborne illness

A
  1. Toxoplasma gondii (86/43K/0.02)
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5
Q

Inflammatory diarrhea, agents (foodborne)

A
  1. Salmonella
  2. Campylobacter
  3. Shigella
  4. E. coli, enterohemorrhagic
  5. Yersinia
  6. Vibrio parahemolyticus
  7. Entamoeba histolytica
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6
Q

Watery diarrhea, agents (foodborne)

A
  1. Norovirus
  2. Clostridioides
  3. Clostridium perfringens
  4. E. coli, enterotoxigenic
  5. Rota, astro, sapo, adenovirus
  6. Giardia lamblia
  7. Cryptosporidium parvum
  8. Listeria monocytogenes
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7
Q

Norovirus seasonality

A

Anytime, highest Nov-April

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8
Q

Norovirus inoculum transmission required

A

<100 viral particles

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9
Q

Norovirus routes

A
  1. Fecal-oral
  2. Airborne vomitus droplets
  3. Fomites
  4. Contaminated foods and water (greens, fresh fruit, shellfish)
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10
Q

Norovirus stability

A

Extreme environmental stability, resists freezing and heating to 60ºC and chlorine and EtOH

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11
Q

Noroviral shedding period

A

⬆︎risk first 24-48HR post-onset; mean duration 4WK

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12
Q

Norovirus outbreaks

A

Cruise ships
Resorts
Community/education settings
Hospitals
Restaurants/catering
Prisons

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13
Q

Norovirus immunity

A

Some immunity = same genogroup; less immunity = diff genogroup

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14
Q

Norovirus symptoms

A

May be asymptomatic carrier (esp after repeated exposure)

  1. Nausea, vomiting (explosive) (nonbloody, nonbilious)
  2. Watery diarrhea (explosive)(nonbloody)
  3. Abdominal pain
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15
Q

Norovirus return to activity

A

Isolate until 48-72HR post sx resolution

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16
Q

First line management for traveler’s diarrhea

A

Oral rehydration, dietary modification as needed (BRAT or to tolerance)

17
Q

Typical course for traveler’s diarrhea

A

3-5 days

18
Q

Predominant pathogen implicated in traveler’s diarrhea

A

Enterotoxigenic Escherichia coli (ETEC)

19
Q

Home recipe for oral rehydration solution

A

0.5 tsp table salt, 0.5 tsp baking soda, 4 Tbsp sugar, 1 liter water

20
Q

BRAT diet for GI disorders?

A

Limited evidence, should eat or not eat to tolerance, which often means mild, bland diet such as BRAT, oral fluids most important

21
Q

First line antibiotic for traveler’s diarrhea

A

Azithromycin 1 g PO once; or azithromycin 500 mg PO daily x3

22
Q

Fluoroquinolones for traveler’s diarrhea

A

No longer recommended d/t increased microbial resistance; use selectively; teratogenic

23
Q

Antimotility agent use in diarrhea

A

Loperamide only if non-dysenteric (blood, mucus) diarrhea

24
Q

Possible sequela of antimotility agents in invasive inflammatory diarrhea

A

Toxic megacolon

25
Q

Other microbes implicated in traveler’s diarrhea

A

Giardia, Shigella, Campylobacter, Entamoeba, Strongyloides

26
Q

When to suspect less common causes of traveler’s diarrhea

A

Persistent diarrhea >10-14 days despite standard care

27
Q

Important diarrheal pathogens in MSM

A

Giardia, Shigella, E.histolytica

28
Q

Alternative antimicrobial agents for traveler’s diarrhea

A

Rifaximin and rifamycin; avoid in invasive diarrhea

29
Q

Infectious causes of toxic megacolon

A

Clostridioides difficile; Salmonella; Shigella; Campylobacter; Yersinia; Entamoeba histolytica; Cryptosporidium; CMV; Kaposi sarcoma

30
Q

Most common non-infectious causes of toxic megacolon

A

Ulcerative colitis > Crohn’s disease

31
Q

Helicobacter pylori testing

A

Stool antigen; urea breath testing

32
Q

Testing for active H. pylori infection

A

Stool antigen and urea breath testing have comparable performance; antigen testing is typically easier to collect and more cost effective; UBT fails often during collection, storage or transportation due to lab tech unfamiliarity

33
Q

Leptospirosis incidence in US

A

Low incidence, 100-200 cases/year; >half in Hawaii

34
Q

Leptospirosis distribution

A

Tropics; Australia, South America, Africa,

35
Q

Considerations for empiric treatment for dysenteric/bloody diarrhea

A

Recommend azithromycin 500 mg PO x3 days (not 1 g once); consider adding metronidazole to cover anaerobes and protozoans

MI Internal Medicine and Infectious Disease (35 decks)

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