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ID Boards > GI > Flashcards

GI Flashcards

1
Q

Pathogens that cause persistent/chronic diarrhea

A
  • cryptosporidium
  • giardia
  • cyclospora
  • cystoisospora
  • entamoeba histolytica
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2
Q

Pathogens that cause bloody stool

A
  • STEC
  • shigella
  • salmonella
  • campy
  • entamoeba histolytica
  • noncholera vibrio species
  • Yersinia
  • balantidium coli
  • plesiomonas
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3
Q

Pathogens that cause persistent abd pn and F

A
  • yersinia enterocolitica/pseudotuberculosis (may mimic appy)
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4
Q

Pathogens that cause N/V lasting <24hrs

A

staph aureus or bacillus cereus toxin ingestion

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5
Q

vomiting and non-bloody diarrhea lasting 2-3 days or less

A

norovirus (remember the criteria)

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6
Q

GI pathogens w/ aortitis, osteomyelitis, deep tissue infection

A

salmonella

yersinia

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7
Q

GI pathogens a/w intestinal perf

A
  • salmonella
  • shigella
  • campy
  • yersinia
  • entamoeba
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8
Q

GI pathogens a/w postinfectious IBS

A
  • campy
  • salmonella
  • shigella
  • STEC
  • giardia
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9
Q

GI pathogens a/w hemolytic anemia

A
  • campy
  • yersinia
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10
Q

GI pathogen a/w IgA nephropathy

A

campy

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11
Q

GI pathogens a/w glomerulonephritis

A
  • shigella
  • campy
  • yersinia
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12
Q

GI pathogens a/w HUS

A
  • STEC
  • shigella dysenteriae serotype 1
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13
Q

GI pathogens a/w erythema nodosum

A
  • yersinia
  • campy
  • salmonella
  • shigella
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14
Q

GI pathogens a/w reactive arthritis

A
  • salmonella
  • shigella
  • campy
  • yersinia
  • rare: giardia, cyclospora
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15
Q

Campy epi (sources, transmission)

A
  • normal commensal in GI tract of many wild/domestic animals
  • found contaminating many natural/fresh water sources
    • can survive for weeks at temps <15C
  • direct transmission from infected animals, P2P (rare, but w/ nursery staff, MSM)
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16
Q

Complications of Campy

A
  • Reactive arthritis
    • 2.6%
    • often a/w presence of HLAB27
    • 1-2wks after infection - small joints, wrists, knees, ankles
    • can last wks-mos
  • Guillanin-Barre
    • 3-40% linked w/ campy
    • 1-2wks after infection
    • a/w molecular mimecry - GM1 ganglioside, present in peripheral nerve myelin
  • Miller Fischer (GBS variant)
  • Colitis (can mimic IBD)
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17
Q

Complications of Salmonella GI infection

Indications for tx

A
  • Complications
    • achlorhydria, IBD, SCD = tends to have more severe infection
    • bacteremia → mycotic aneurysms, abscesses, osteo, IE/endovascular infections
  • Indications to consider tx
    • IS state (including advanced HIV)
    • age >50yo (high risk ~10% for endovascular infection w/ bacteremia d/t atherosclerotic disease)
    • <12mos old (high risk of neurologic infection and mortality)
    • stools >9-10/day
    • persistent F
    • hospital admission
    • CV/valvular disease
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18
Q

Step-wise progression of symptoms of Typhoid/Enteric fever (salmonella enterica subtype typhi or paratyphi)

A
  1. ​Week 1 - bacteremia w/ F>40C with chills
    1. can see temp-pulse dissociation
  2. Week 2
    1. abd pn
    2. rose spots (faint salmon-color transient spots)
  3. Week 3 - abd perf d/t necrosis and lymphatic hyperplasia of Peyer’s patches
    1. secondary bacteremia can occur
    2. HSM
    3. intestinal bleeding
    4. can lead to septic shock
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19
Q

shellfish ingestion ⇒ GE, cellulitis, bullous lesions (esp in cirrhotic pts)

A

Vibrio vulnificas

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20
Q

travel to mountainous regions (eg Russia, Nepal)

MSM

A

Giardia (MC)

cyclospora

cryptosporidia

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21
Q

C perfringens types

A

(a/w undercook/poorly stored meat products, gravy)

  • Type A - often cause of outbreaks
    • can cause gas gangrene in pts w/ necrotic bowel
  • Type C - produces hemorrhagic necrosis of jejunum
    • enteritis necroticans toxin (pigbel disease - d/t pork exposure)
    • most prominently seen in children w/ protein malnutrition (i.e. developing worlds) and diabetics in developed world
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22
Q

what organisms can cause post-GE reactive arthritis

A
  • salmonella
  • shigella
  • yersinia

d/t Ab-mediated autoimmune molecular mimicry (targeting epitopes common to pathogen and joint tissues)

23
Q

Pt w/ dysenteric traveler’s diarrhea who takes cipro

What is most concerning?

  1. Colonization by ESBL-prod coliforms
  2. Achilles damage
  3. CDI
  4. Insomnia, irritability
A

1! The others can occur, but this is most concerning and the correct answer on the boards

24
Q

tx for pt with dysenteric traveler’s diarrhea

A

azithromycin 1g (campy or shigella - none responsive to quinolones d/t R)

25
Q
  • bloody diarrhea w/ renal failure
  • Hct low, LDH high, peripheral smears w/ RBC fragments
  • colonoscopy can look like ischemic colitis
  • stool cx: sorbitol MacConkey - sorbitol negative

dx and tx?

A
  • E Coli Non-O157 (Shiga toxin-producing) - hint that O157:H7 is sorbitol-producing
  • Elderly pts (esp w/ vascular disease) can develop ischemic colitis w/ HUS
  • **Shiga toxin 2 (not 1) a/w HUS

tx w/ eculizumab

26
Q

clinical/epi criteria for norovirus

A
  1. no bacterial causes identified
  2. incubation 24-48hrs
  3. duration of illness 12-60hrs
  4. vomiting in > 50%
27
Q

vomiting w/in 24-48hrs

what if with fever?

A
  • viral GE
  • fever = viral GE
28
Q

tx for intestinal amoebiasis

A

metro + diloxanide or paromomycin

29
Q

tx for cyclosporiasis/cystososporiasis

A

TMP/SMX

30
Q

tx for cryptosporidiosis

A

nitazoxanide

31
Q

tx for giardiasis

A

tinidazole or nitazoxanide

32
Q

tx for cholera

A

doxy

33
Q

tx for non-cholera vibrio

A

fluoroquinolones or azithromycin

34
Q

tx for campy

A

azithromycin

35
Q

treatment for non-typhoid salmonella (only w/ sepsis)

A

fluoroquinolones or 3rd gen cephalosporin

36
Q

Tx for shigellosis

A

fluoroquinolone or azithromycin

37
Q

when is testing appropriate for traveler’s diarrhea

A

if persistent >14 days

38
Q

locations at highest risk for ESBL or MDR enterobacterales traveler’s diarrhea

A

travel to tropical/subtropical regions (esp Asia) - highest risk = India

39
Q

improperly refrigerated/preserved tuna, mackerel, amberjack, marlin

*?peppery, sharp, salty taste?

flushing, HA, palpitations, itching, diarrhea

w/in 10-60min - lasts up to 12hrs

A

scombroid

40
Q

toxin inhaled from algal blooms (eg surfing red tide)

A

neurotoxin inhalation or shellfish poisoning (toxin from Karenia brevis)

worse in asthmatics

41
Q
  • mollusks around coral reef in Caribbean/Pacific regions
  • sx w/in 3-6 (up to 30) hrs
  • GI sx
  • hot/cold reversal
  • numbness/paresthesias
A

ciguatera

42
Q

numbness/tingling 30-60min after eating mollusk

can result in respiratory failure in severe cases

(does not have GI or neuro sx)

A

paralytic shellfish

43
Q

Diarrhea >14 days

A

cryptosporidium

44
Q

Diarrhea > 14 days

A

Entoemba histolytica

45
Q

Diarrhea > 14 days

A

Giardia

46
Q

High risk groups for complications of non-typhoid salmonellosis

A

(i.e. higher rate of deep mucosal penetration in these populations –> leading to secondary bacterial infection)

**these groups require treatment

  • elderly
  • infants (1-3mos)
  • SCD
  • IBD (whether on drugs or not)
47
Q

Tx for Shiga-toxin induced HUS

A

eculizumab (beware meningococcal infections)

48
Q

Infectious agents that have low communicability (require high inoculum, often don’t result in outbreaks)

A
  • E coli (Shiga toxin-producing)
  • campy

**require 500-100,000 organisms

49
Q

Infectious agents with no communicability

A

ETEC/EIEC, vibrio

(only food/water - never P2P)

50
Q

Infectious agents with high rates of transmissibility

A
  • Highest (10-100 orgs req): shigella, norovirus
  • High rate (80-500 orgs req): giardia, cryptosporidium, salmonella (in infants)
51
Q

Micro for pyogenic liver abscess

A
  • usually enteric bacteria (including strep milleri group)
  • Kleb pneumoniae, esp in Asia - K1 serotype = hypermucoviscous variant
  • in IC pts: consider yersinia enterocolitica and candida
  • from SE Asia/N Australia: consider melioidosis (B pseudomallei)
52
Q

Tx of pyogenic liver abscess 2/2 melioidosis

A

>2wks ceftaz, mero, or imi → >3mos Bactrim +/- doxy

53
Q

parasites that obstruct the biliary tree

A
  • Fasciola hepatica
  • Clonorchis sinensis
  • Opisthorchis spp
  • Ascaris lumbricoides
54
Q

undulant fevers, malodorous perspiration, osteoarticular disease (SI jt)

can cause splenic infection w/o abscess formation

A

consider brucellosis (esp w/ epi RFs)

exposure to infected animals/unpasteurized dairy

Africa, Middle East

ID Boards (24 decks)

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