GI infections Flashcards by Jacqui Joseph

what does Rotavirus cause?

small bowel intussusception/obstruction, severe dehydration

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what is intussusception?

Intussusception occurs when a portion of the intestine folds like a telescope, with one segment slipping inside another segment. … The result can be a blocked small bowel or colon

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is there a risk for intussusception with the rotavirus vaccine?

not with the newer vaccine!

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who gets rotavirus?

children < 2yo (at highest risk)

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labs for rotavirus?

look for rotavirus in stool sample

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txt for rotavirus

supportive & oral rehydration (with proper electrolyte liquids)

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what are good rehydration liquids vs bad?

good ones have good electrolyte and osmolarity profile (ex: pedialyte vs gatorade or apply juice)

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salmonella, shigella and Enterotoxic E.Coli are all ____ illnesses

food-borne

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what is the #1 cause of foodborne illness in the US?

Salmonella

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Salmonella is the ___ most common cause of death from foodborne pathogens in the US

2nd

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why is Salmonella so hard to get rid of?

Forms a thick coating on equipment used for food processing

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what foodborne pathogen causes bacillary dysentery and acute watery diarrhea?

Shigella

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what is bacillary dysentery

a certain kind of intestinal infection from shigella

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where is shigella illness usually found? why?

outside the US, in developing world. The US doesn’t have the bacteria that take Shigella and make the Shigella Toxin

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presenting symptoms of shigella

sudden high fever, bloody diarrhea of a small volume, acute watery diarrhea.

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avoid what kind of drugs with shigella?

antimotility drugs- may prolong the duration of symptoms

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Abx for those with shigella?

only for those who are VERY sick, indicated for children and adolescents with culture-proven shigella and who …
have bacteremia, require hospitalization, at risk, etc.

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where does one get giardia from ?

water-born or food-borne diarrhea, day-care outbreaks, international travelers, adoptees

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how is Giardia transmitted?

fecal-oral transmission

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what are the common symptoms of giardia ?

major ones; malaise, diarrhea (very bad smelling!), steatorrhea

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txt for giardia

supportive- oral rehydration

Abx: azoles (metronidazole aka flagyl)

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giardia may cause a temporary _____ ______

lactose intolerance

prevention for giardia

avoid daycare, water purification

Cdiff AKA …

Abx- associated colitis

what does Cdiff come from ?

frequently part of normal flora, colonizes GI tract after normal gut flora have been altered by Abx therapy

whose at risk for Cdiff?

elderly

the presence of Cdiff in stool means what?

Does NOT mean you have the Cdiff infection (colitis). Cdiff is present in almost everyone at some level.

what is the cardinal clinical symptom of Cdiff?

watery diarrhea

Cdiff symptoms range from ____ to ____

asymptomatic to fulminant disease with toxic megacolon

____% of hospitalized adults are Cdiff carriers, up to ___% in longterm care centers.

20- hospital | 50- LTCs

Cdiff may occur during _____ or ______

Abx administration or following, up to several weeks

biggest culprit of causing Cdiff?

Clindamycin | - also fluoroQs, cephalosporins, PCNs

Cdiff- exam generally demonstrates ...

lower abd tenderness

endoscopy for Cdiff can show ...

spectrum of findings, from patchy erythema to severe pseudomembranous colitis

if someone doesnt have watery diarrhea will you send a stool sample to lab?

NO, no point, likely not Cdiff

The Dx of Cdiff infection requires...

presence of severe diarrhea or ileus AND either positive stool test, OR endoscopic or histologic findings of pseudomembranous colitis

what is pseudomembranous colitis look like?

thick, gunky, white layer inside the colon | looks like cottage cheese

what does an enzyme immunoassay (EIA) for Cdiff show?

shows toxins A&B and for glutamate dehydrogenase ( the best indicator)

GDH antigen does or does not distinguish toxigenic form nontoxigenic strains?

does not!

dont want to treat benign Cdiff with Abx, why?

cause you can cause Cdiff infection!

what is the order of labs to draw for Cdiff?

1. test the 2 EIA types: if both + then txt for Cdiff, if both - then dont txt for Ciff 2. If on is + and one - , then do NAAT testing

what does PCR/NAAT testing do for Cdiff?

tests for toxin A and B, does not test for the presence of actual toxin. (nucleic acid testing)

PCR/NAAT has high sensitivity and therefore will lead to ...

frequent identification of incidental carriers. its too sensitive, does not discriminate between infection and carriers.

Txt regiment for Cdiff (4 parts)

1. stop inciting Abx 2. infection control (contact precautions) 3. if more than mild, txt with 10-14 days ORAL vancomycin or Dificid (second line flagyl) 4. surgery if severe (partial or total colectomy)

relapse is ___% with Cdiff

recent 3 phase study suggests ____ is "noninferior" to vancomycin for Cdiff (actually that its better! )

fidaxomicin

what abx is good for refractory Cdiff?

Rifaximin

imaging for Cdiff?

if very sick, consider CT

fecal transplants for Cdiff have a ___% cure rate.

fecal transplants for Cdiff can be given via ___ or ____ . who are the best donors?

enema or NG tube | donor: family members, family dog, etc.

tests for Cdiff must have Cdiff bacteria AND what?

the cdiff toxin!

what pathogen is traveler's diarrhea from?

- most commonly enterotoxigenic E.Coli (not the enterohemorrhagic E coli from Jack in the Box) - Cholera possibly in endemic area

Traveler's diarrhea causes....

usually benign and self-limited but can cause severe dehydration.

txt for traveler's diarrhea

1. single dose azithromycin 2. antimotility agents (imodium) - but should ALWAYS be combined with an Abx 3. pepto bismol good but need very large doses for txt