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GI Infections Flashcards

1
Q

Gastroenteritis

A

inflammation of the stomach/intestine. Nausea, diarrhea, vomiting, cramps, malaise, anorexia, myalgias, HA.

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2
Q

Viral Gastroenteritis treatment

A

oral re hydration with electrolytes and sugar. No role for antibiotics.

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3
Q

Viral Gastroenteritis etiologies

A

Rotavirus, enteric adenovirus, caliciviruses (norovirus).

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4
Q

Infant viral diarrhea

A

less than 2 years old. Transmission occurs even with good sanitation because caregiver can act as the reservoir. Usually rotavirus and enteric adenovirus.

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5
Q

Viral diarrhea outbreaks

A

Usually norovirus. Fecally contaminated food. Effects older children and adults.

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6
Q

Rotavirus

A

Endemic severe diarrhea of infants. Humans act as the reservoir.

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7
Q

“winter vomiting disease”

A

Rotavirus. Starts in the southwest (november) and spreads northeast until may.

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8
Q

Rotavirus Course length

A

5-7 days

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9
Q

Rotavirus symptoms

A

fever and vomiting.

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10
Q

Enteric Adenovirus

A

Endemic diarrhea of infants

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11
Q

Enteric Adenovirus Symptoms

A

Diarrhea, fever and vomiting

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12
Q

Enteric Adenovirus Course

A

Occurs anytime of year. Lasts 5-12 days.

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13
Q

Calicivirus (norovirus)

A

Epidemic of diarrhea/vomiting in older children and adults.

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14
Q

Calicivirus (norovirus) Course

A

Self-limited 24-48 hours.

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15
Q

Calicivirus (norovirus) associaiton

A

Food, especially shellfish. Can spread person-to-person (cruise ships).

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16
Q

Cholera Etiology

A

Vibrio Cholerae. Colonize the small intesine mucosa with no change in physical integrity. High dose pathogen.

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17
Q

Cholera description

A

Gram negative, bent rod, nonspore forming, facultative anaerobe, motile (polar flagellum).

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18
Q

Cholera symptoms

A

Acute. Watery diarrhea (rice water stools), muscle cramps, wrinkled skin (washerwoman’s hands), poor turgor, sunken eyes, missing peripheral pulses. Hypovolemic shock, metabolic acidosis and death.

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19
Q

Cholera toxin

A

Choleragen. Creates the watery diarrhea. Same toxin as enterotoxigenic E. coli.

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20
Q

O-1 Cholera

A

Classic epidemic cholera

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21
Q

O-139 Cholera

A

newly recognized in south asia. Can cause disease in those already immune to O-1.

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22
Q

Cholera treatment

A

Replace fluids and electrolytes. Antibiotics may shorten the course of the disease.

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23
Q

Cholera reservoir

A

Marine coastal areas and estuaries. Can then spread through contaminated drinking water and food (sushi, oysters).

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24
Q

Cholera vaccines

A

Shanchol and Dukoral

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25
Q

Cholera prevention

A

Proper sewage control and sanitation.

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26
Q

V. Parahaemolyticus reservoir

A

coastal ocean areas and estuaries. Recedes during the winter.

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27
Q

V. Parahaemolyticus Symptoms

A

Gastroenteritis to a mild cholera-like illness

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28
Q

V. Parahaemolyticus prevention

A

Proper refrigeration especially of seafood.

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29
Q

V. Vulnificus Reservoir

A

coastal waters, especially oysters. Recedes during winter.

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30
Q

V. Vulnificus presentation

A

1.) wound infections
2.) acute self-limiting diarrhea (oysters)
3.) sepsis: bullous skin lesions, shock, liver dysfunction.
High death rate ~50%

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31
Q

Excherichia coli causes

A

changes in the gut structure by making pedicles. O antigen=serogroup, H antigen=serotype.

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32
Q

086 E. coli

A

Normal flora

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33
Q

055 E. coli

A

Disease causing

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34
Q

Enterotoxigenic E. coli (ETEC)

A

Common cause of food poisoning outbreaks. Resembles V. cholerae (same toxin). Travelers diarrhea.

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35
Q

ETEC symptoms

A

afebrile with watery diarrhea.

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36
Q

Enterohemorrhagic E. coli (EHEC) strain

37
Q

EHEC reservoir

A

Cows. Beef, raw milk. Can have person-to-person transmission. Veggies may become cross contaminated with cow manure.

38
Q

EHEC toxin

A

Shiga toxin. Named shiga toxin producing E. coli (STEC).

39
Q

EHEC symptoms

A

Diarrhea that becomes bloody after 1-3 days of cramps and vomiting. Half also have fever.

40
Q

EHEC complications

A

hemolytic uremic syndrome (HUS): kidney failure due to clots.

41
Q

EHEC Diagnosis

A

Can’t ferment sorbitol so appears white on MacConkey’s agar. Have to request this from the lab if EHEC is suspected.

42
Q

EHEC Treatment

A

Re hydration. Avoid antibiotics (causes huge release of shiga toxin at once). Don’t use anti-motility agents in kids.

43
Q

Enteroaggregative E. coli strain

44
Q

Enteroaggregative E. coli Reservoir

A

Alfalfa sprouts. High fatality due to large amounts of shiga toxin.

45
Q

Campylobacter jejuni description

A

Gram negative, curved rod, motile, microaerophilic, grows best at 42 degrees C.

46
Q

Campylobacter jejuni reservior

A

Birds. Transmission usually occurs due to undercooked chicken. Peaks in summer. Low dose pathogen.

47
Q

Campylobacter jejuni Prodrome

A

fever, HA, malaise, myalgias usually 12-24 hours before onset of diarrhea.

48
Q

Campylobacter jejuni symptoms

A

Enteritis with diarrhea, fever, abdominal pain (mimics appendicitis). Self-limiting, improves in several days.

49
Q

Campylobacter jejuni Carrier

A

Convalescent carrier for 2-3 weeks.

50
Q

Campylobacter jejuni epidemiology

A

Young adults

51
Q

Campylobacter jejuni complications

A

Reiter’s syndrome and guillian-barre syndrome

52
Q

Campylobacter jejuni diagnosis

A

Prescence of a prodrome and fever.

53
Q

Helicobacter Pylori Reservoir

54
Q

Helicobacter Pylori Description

A

Gram negative, curved rods, highly motile, stain best with a tissue biopsy and giemsa. Copious production of urease.

55
Q

Helicobacter Pylori Symptoms

A

Active gastritis: cramps, halitosis, nausea, vomiting. Peptic ulceration: invades mucosa and creates urease leading to ulceration. Can lead to stomach adenocarcinoma.

56
Q

Helicobacter Pylori diagnosis

A

histological detection with biopsy pluse culture. Can detect urease activity with the CLO test.

57
Q

Helicobacter Pylori treatment

A

Antibiotics (tetracycline) with bismuth containing drugs.

58
Q

Shigella Description

A

Highly infectious enteric pathogen. Gram negative, nonspore forming, facultative anaerobe, nonmotile, nonlactose fermenting (differentiates between E. coli).

59
Q

Shigella symptoms

A

fever, cramps, vomiting, watery diarrhea that progresses into dysentery (blood, mucous, PMNs in the stool).

60
Q

Shigella Transmission

A

person-to-person. Most common in kids 1-4 years old.

61
Q

Shigella Diagnosis

A

Suspect in any patient with a fever and diarrheal disease. Acute onset with blood/mucous in the feces. Microscopic eval will show PMNs and RBCs.

62
Q

Shigella Treatment

A

Self-limitng, fluid replacement. Very antibiotic resistant but an effective antibiotic can shorten the duration and eliminate carriers.

63
Q

Shigella complications

A

Long term carrier state, Reiter’s syndrome, HUS.

64
Q

Shigella species

A

A: S. dysenteriae
B: S. Flexneri (US)
C: S. boydii
D: S. sonnei (US)

65
Q

Salmonellae Reservoir

A

Normal gut flora in cows, pigs, chickens, cats, dogs, and reptiles. During the summer and fall. Due to improper food handling.

66
Q

Salmonellae symptoms

A

sudden onset of fever, chills, cramps, diarrhea, vomiting that lasts 2-3 days. Can be convalescent carrier for months.

67
Q

Salmonellae high risks

A

very young and very old. Cancer, aids, DM, antibiotic use.

68
Q

Salmonellae description

A

Gram negative, nonspore forming, facultative anaerobe, motile, non lactose fermenting.

69
Q

Salmonellae diagnosis

A

Microscopic: fecal leukocytes. Culture. Presence of blood if feverish. Flourescent antibody tests. Serological confirmation.

70
Q

Salmonellae Treatment

A

supportive. Antibiotics only if the disease becomes systemic.

71
Q

Clostridium difficile description

A

Gram positive, rods, anaerobic, spore forming.

72
Q

C. diff causes

A

Antibiotic induced pseudomembranous colitis. Antibiotics: clindamycin, cephalosporins, ampicillin and some antineoplastics.

73
Q

C. diff Presentations

A
  1. ) diarrhea with cramping
  2. ) sever colitis: profuse diarrhea, pain with systemic infection (fever, nausea, malaise)
  3. ) Classic psuedomembranous colitis: elevated yellow plaques over inflamed regions of mucosa. Psueomembranes (fibrin mesh of necrotic cells) present in feces.
74
Q

C. diff diagnosis

A

toxin detection with latex agglutination test. Gram stain (positive).

75
Q

C. diff treatment

A

supportive. Discontinue offending antibiotics.

76
Q

Clostridium perfringens type A description

A

Acute food-bourne diarrhea. Gram positive, non motile, aerotolerant, spore forming.

77
Q

Clostridium perfringens type A Transmission

A

Consumption of grossly contaminated meat/poultry. Cooked food is then left out too long.

78
Q

Clostridium perfringens type A Diagnosis

A

Must isolate large numbers form the feces and the food.

79
Q

Clostridium perfringens type A symptoms

A

Short incubation. Moderate-severe diarrhea and cramping with complete recovery in about a day.

80
Q

Bacillus Cereus Description

A

Gram positive, aerobic, motile, spore forming.

81
Q

Bacillus Cereus presentations

A
  1. ) Emetic form: Due to preformed toxin, upper GI symptoms 1-5 hours after ingestion. vomiting, diarrhea, cramps.
  2. )Diarrheal form: ingestion of a large number of vegetative cells that produce toxin. abdominal pain, profuse diarrhea. 1-17 hours after ingestion.
82
Q

Bacillus Cereus Diagnosis

A

Afebrile with quick onset (1-5 hours) of eating. Have to isolate more than 10^5 per gram from the stool.

83
Q

Bacillus Cereus reservoir

A

Spores are commonly found on grains, veggies and especially rice.

84
Q

Bacillus Cereus prevention

A

Prompt refrigeration of cooked grains

85
Q

Staphlococcal Presentation

A

Acute emetic/diarrheal disease (1-6 hours). Nausea, vomiting, diarrhea, cramps, acute salivation. Self-limiting

86
Q

Staphlococcal toxin

A

Enterotoxin A: water soluble, heat stable. Emetic=enters CNS and vomiting center. Diarrheal=decreased water absorption.

87
Q

Staphlococcal transmission

A

custard baked goods, canned food, processed meat, potato salad.

88
Q

Staphlococcal reservoir

A

Humans. Disease without colonization. Second most common cause of food poisoning behind salmonella.

Microbiology (4 decks)

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