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IInfectious Disease > GI Disease > Flashcards

GI Disease Flashcards

1
Q

Travel

A

ETEC

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2
Q

1-6 hours of incubation after eating

A
  • Toxin mediates
  • S, aureus (mayo, crea, ham, poultry)
  • B. cereus (enterotoxin) fried rice
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3
Q

8-14 hours of incubation after eating

A

• C. perfringes (beef, poultery, legumes, gravy)
• B. cerus (meat, vegetables, dried beans, cereals)
/

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4
Q

> 16 hours of incubation after eating

A
  • V. cholera – shellfish
  • V. parahemolyticus (oysters, shellfish)
  • ETECH (sald, cheese, meat, water)
  • Salmonella (beed, pultry, eggs, dairy)
  • Shigella (potato or egg salad, raw vegetables)
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5
Q

Antbiotic use diarrhea

A

C, difficile

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6
Q

Diarrhea associated with sex

A

Shigella

Hep A

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7
Q

Diarahea at the extremes of age

A

Rota virus

Noravirus

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8
Q

Diarhea with reptiles & amphibians

A

Salmonella enterica

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9
Q

Diarrhea in pregnancy

A

Listeria

Hep E

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10
Q

DIarrhea in HIV

A
  • Crypyosporifum
  • Microsporidium
  • Cyclospora
  • Isoposa
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11
Q

Medications with diarhea

A
  • NSAIDs
  • Colchicine
  • Meticlopramide
  • Radition
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12
Q

Non-inflmatory diarhea

Key Organisms
Location in GI tract
Stool/clinical findings

A
  • V, cholera
  • C. perfringens
  • B. Cerus
  • ETEC
  • Rotavirus
  • Giardia
  • Cryptosporidium

• Proximal small bowl

  • Watery stool
  • No WBC
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13
Q

Inflammatory Diarhea

Key Organisms
Location in GI tract
Stool/clinical findings

A
  • Shigella
  • Samonella (non typhi)
  • Camplobacter
  • EHEC
  • EIC
  • Colon/terminal ileum
  • Dystenry (bloody stool)
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14
Q

Penetrating Diarhea

Key Organisms
Location in GI tract
Stool/clinical findings

A
  • S. typhi
  • Y. enerocolittica

• Distal small bowel

  • Enteric fever
  • Fecal WBC
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15
Q

Clinical definition of diarrhea

A

3 loose stools in 24 hrs

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16
Q

Acute, Chronic & resistant diarrhea

A
  • Acute diarrhea: 0-14 days
  • Persistent: 14-30 days
  • Chronic: > 30 days
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17
Q

Workup for diarrhea

A 
•	Lactoferrin (WBC digestion product)
•	Fecal WBC
Stool culture
•	Ova & Parasitis
•	C. diff toxin by PCR or antigen
•	Endoscopy: IBD, cancer
18
Q

Noravirus

Pathophysiology
Epi
Presentation
Diagnosis
Treatment
A
  1. Pathophysiology – damages brush border, preventing absorption of water and nutrients
  2. Epidemiology – outbreak association
  3. Clinical - acute onset of vomiting (especially in kids), low grade fever in 1/3, abdominal cramps
    and/or nonbloody diarrhea (especially in adults) within 10-48 hours of exposure. 30% secondary attack
    rate. Duration 1-2 days in normal host.
  4. Diagnosis – PCR confirmation (state public health lab)
  5. Treatment – supportive
19
Q

Rotavirus

Pathophysiology
Epi
Presentation
Diagnosis
Treatment
A
  1. Pathophysiology: activated by proteolysis to infectious subviral particles
  2. Epidemiology:Main cause of pediatric diarrhea, important cause of global infant mortality. Highest
    infection rates at ages 3-15 months
  3. Clinical: 2 day incubation. Vomiting and watery diarrhea for 3-8 days, can be associated with fever
    and abdominal pain.
  4. Diagnosis: rapid antigen detection in stool.
  5. Treatment: Supportive. Preventative vaccine available.
20
Q

Shigella

Pathophysiology
Epi
Presentation
Diagnosis
Treatment
A
  1. Pathophysiology: invasion of colonic epithelial cells, causing superficial ulcerations, colitis with
    crypt abscesses; impaired absorption of water and electrolytes through the colon produces diarrhea
  2. Epidemiology: 12-72 hour incubation, fecal-oral transmission, predilection for children, daycare,
    poor sanitation, MSM.
  3. Clinical: dysentery, moderate to severe illness with fever and blood flecks in stool; lasting 1-2
    weeks, children can develop hemolytic uremic syndrome due to shiga toxin, mortality
21
Q

Salmonella typhi

Nora Virus

Pathophysiology
Epi
Presentation
Diagnosis
Treatment
A
  1. Pathophysiology: ingested organisms reach small bowel, penetrate mucosa, carried to lymph nodes
    and blood with secondary excretion into intestine from bile.
  2. Epidemiology: 10 day incubation, human reservoir only.
  3. Clinical: systemic illness with insidious onset of malaise, myalgias, headache and high fever. Classic
    rose spots and temperature-pulse disassociation. Complications include intestinal perforation
    and chronic carriage.
  4. Diagnosis: 80% positive blood cultures in early state, stool cultures positive late.
  5. Treatment: ampicillin, TMP/SMX, ciprofloxacin
  6. Prevention: live oral vaccine
22
Q

Salmonella enteriditis or typhimurium

Pathophysiology
Epi
Presentation
Diagnosis
Treatment
A
  1. Pathophysiology: pili adhere to small intestine where enterotoxin stimulates fluid secretion.
  2. Epidemiology: 12-36 hour incubation, numerous animal reservoirs (poultry, eggs)
  3. Clinical: gastroenteritis with sudden onset of nausea, crampy abdominal pain, diarrhea and fever.
  4. Diagnosis: stool culture
  5. Treatment: mild cases treated with fluids. Treat only for severe disease, immune compromise or
    extremes of age (TMP/SMX or ciprofloxacin).
23
Q

Campylobacter jejuni

Pathophysiology
Epi
Presentation
Diagnosis
Treatment
A
  1. Pathophysiology: invasive disease of ileum and colon with inflammatory diarrhea
  2. Epidemiology: 1-7 d incubation, many animal reservoirs, transmission in poultry, unpasteurized
    milk, water.
  3. Clinical: 12-24 prodrome of HA, myalgias, fever then acute diarrhea with >10 loose, non bloody
    BM/day. Lasts 5-7 days.
  4. Diagnosis: stool culture
  5. Treatment: controversial. (Cipro effective in vitro.)
24
Q

EPEC
ETEC
EIEC
EHEC

A
  1. Enteropathogenic E coli (EPEC): adheres to and destroys microvilli, important cause of childhood
    diarrhea in developing countries.
  2. Enterotoxigenic E coli (ETEC): milder, cholera-like watery diarrhea from production of enterotoxin
    (LT or ST). Often causes traveler’s diarrhea.
  3. Enteroinvasive E coli (EIEC) shigella like inflammatory diarrhea
  4. Enterohemorrhagic E coli (EHEC): cytotoxin causes bloody diarrhea, may be complicated by hemolytic
    uremic syndrome, 0157:H7 often implicated (poorly cooked hamburger outbreaks).
25
Q

C. difficile

Pathophysiology
Epi
Presentation
Diagnosis
Treatment
A
  1. Pathophysiology: anaerobic toxin producing bacteria causes diarrhea and can cause pseudomembranous
    colitis.
  2. Epidemiology: antibiotic associated, 4-9 day incubation
  3. Treatment: Oral metronidazole. Oral vancomycin for severe illness.
26
Q

Yesina enterocolitic

Pathophysiology
Epi
Presentation
Diagnosis
Treatment
A
  1. Pathology: mucosal ulcerations and mesenteric adenitis, intracellular pathogen.
  2. Epidemiology: animal reservoir with outbreaks from food and water.
  3. Clinical: appendicitis like syndrome from mesenteric adenitis, diarrhea and fever.
  4. Diagnosis: slow growth makes fecal isolation difficult.
  5. Treatment: tetracycline, TMP/SMX
27
Q

V. parahemolyticus

Pathophysiology
Epi
Presentation
Diagnosis
Treatment
A

Vibrio parahemolyticus

  1. Pathophysiology: mild tissue damage and watery diarrhea suggesting both invasion and toxin formation
  2. Epidemiology: 24-hour incubation, inadequately cooked seafood
  3. Clinical: explosive watery diarrhea with low grade fever
  4. Diagnosis: stool culture (requires special media)
  5. Treatment: supportive
28
Q

V. cholera

Pathophysiology
Epi
Presentation
Diagnosis
Treatment
A

Vibrio cholera
1. Pathophysiology: non inflammatory toxin acts on small bowel; adenylate cyclase stimulation leads
to increased cAMP and massive isotonic fluid loss
2. Epidemiology: 1-2 d incubation, food and water borne, seafood. Pandemics.
3. Clinical: watery diarrhea (rice-water stool) and dehydration without fever.
4. Diagnosis: stool culture, (requires special media)
5. Treatment: IV/PO fluid replacement. Tetracycline.

29
Q

Listeria monocytogenes

Pathophysiology
Epi
Presentation
Diagnosis
Treatment
A
  1. Pathophysiology: intracellular pathogen, passes through intestines into macrophages and causes
    disseminated infection
  2. Epidemiology: Incubation period 2-6 weeks. Coleslaw, dairy products, cold processed meats. Immunocompromised
    host, extremes of age and pregnant women.
  3. Clinical: Fever, myalgias, bacteremia and meningitis.
  4. Diagnosis: Blood or CSF cultures
  5. Treatment: Ampicillin
30
Q

Main cause of pediatric diarrhea

Vaccine?

A

Rotavirus

Yes

31
Q

Gram + with predilection for children, daycare,

poor sanitation, MSM

A

Shigella

32
Q

Live oral vaccine to prevent diarrhea from this bacteria

A

S. typi

33
Q

Diarrhea & rose spots

A

S. yphi

34
Q

Transmitted by poultery, unpasturized milk & water

A

C. jejeunum

35
Q

E. coli that causes diarrhea in developin countries

A

EPEC

36
Q

E. coli causting travelers diaarrhea

A

ETEC

37
Q

E. coli with shigella like inflmaatory diarrhea

A

EIEC

38
Q

E. coli associated with poorly cooled hamburgers

A

EHEC

39
Q

Bacteria that mimicks apendicitus

A

Yersinia enterocolitica

40
Q

V. cholerea toxin mechanism

A

non inflammatory toxin acts on small bowel; adenylate cyclase stimulation leads
to increased cAMP and massive isotonic fluid loss

41
Q

Rice water stool

A

V. cholerea

42
Q

Diarrhea & myalgia or meningitis

A

Listeria monocytogenes

IInfectious Disease (6 decks)

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