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Block 10 week 5 > GI infections-Hunter > Flashcards

GI infections-Hunter Flashcards

1
Q

(blank) are the most common cause of death in developing countries (2.5 million deaths per year)

A

GI infections

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2
Q

What cause GI infections?

A

Bacteria
Viruses
Parasites

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3
Q

Pathogens causing diarrhea can be transmitted to humans in three basic ways?

A

food
water
person to person

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4
Q

T or F

all GI infections are caused by invading microorganisms; some occur after ingestions of preformed toxins

A

T

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5
Q

How can you tell if a GI infection is caused by a toxin?

A

Symptoms of intoxication such as n/v and diarrhea occur soon after ingestion of the toxin (1-8 hours)

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6
Q

What is this:

infections in the stomach and small intestine; symptoms usually include watery diarrhea, nausea, and vomiting

A

Non-inflammatory gastroenteritis

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7
Q

What is this:

infections in the large intestine often cause dystentery (small fecal volume with mucus and blood)

A

Inflammatory enterocolitis

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8
Q

Non inflammatory gastroenteritis infects what part of the GI system
Inflammatory gastroenteritis infects what part of the GI system?

A

non inflammatory- stomach and small intestine

inflammatory- large intestine

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9
Q

Symptoms of intestinal infections tend to occur much later than intoxications… approximately (blank)

A

24-72 hours

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10
Q

Infectious esophagitis is an infection and inflammation of the esophagus that results in (Blank) and (blank)

A

dysphagia (difficulty swallowing)

odynophagia (painful swallowing)

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11
Q

What is the most common infectious cause of esophagitis is (blank).
What are other important causes?

A

candida albicans

-CMV, HSV, VZV, HIV, Mycobacterium TB

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12
Q

What are risk factors for infectious esophagitis?

A

immunosuppressive conditions
steroid therapy
recent antibiotic use
systemi illness

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13
Q

Fungal, most viral, and mycobacterial esophagitis can be treated with (blank). What is the prognosis?

A

antimicrobials

usually good

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14
Q

What is this:
creamy white plaques in mid distal esophagus. A biopsy is taken and stained with methanamine silver and black pseudohyphae.
What caused it?

A

Esophagitis caused by Candida albicans

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15
Q

(blank) is highly suggestive of infectious esophagitis. This is often seen in (blank) patients.
How do you treat this?

A

Odynophagia
immunocompromised patients
Clotrimazole or parenteral anti-fungal agents (fluconazole)

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16
Q

What are the inflammatory diseases of infectious gastritis?

What is the general term for this?

A

Chronic active gastritis
Gastric ulcer disease
Duodenal ulcer

Peptic ulcer disease

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17
Q

Most PUD is associated with (blank) infeections

A

H. Pylori

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18
Q

H pylori is (short/long), spiral shaped, (bank) gram-negative, (blank)-positive, bacillus that colonized the gastric mucosa.

A

short
microaerophilic
urease

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19
Q

Virulence factors in infectious gastritis, include a cytotoxic protein called (blank) and (blank). Both important in the pathogenesis of (blank) formation

A

vac A (vacuolating toxin)
cagA gene product
ulcer

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20
Q

(blank) is often associated with peptic ulder disease. It often presents with (blank) pain. How do you diagnose it?
what do you use to treat it?

A

H. Pylori
epigastric pain
-endoscopy, antigen tests, urea breath test
-amoxicillin, clarithromycin, omeprazole for 14 days

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21
Q

Chronic H. Pylori infection is a risk factor for (blank)

A

gastric tumors (lymphoma or adenocarcinomas)

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22
Q

Toxin-mediated food poisoning is primarily due to what bacteria? (blank x 4)

A

staph aureus
bacillus cereus
clostridium perfringens
clostridium botulinum

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23
Q

What is the most common cause of food poisoning in U.S? Is it gram positive or gam negative? is it a rod or cocci?

A

staph aureus
gram positive
cocci

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24
Q

Where do people usually get staph aureus food poisoning?

When do symptoms occur?

A

foods that require hand prep such as potato salad, ham salad and sandwhich spreads

within 1-4 hours after ingested contaminated food

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25
Q

S. aureus produces (blank) that cause VOMITING (often projectile) but little or NO DIARRHEA

A

enterotoxins

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26
Q

S. aureus enterotoxins are water soluble, low molecular weight proteins that are (blank) stable

A

Heat stable (resist boiling for 30 minutes)

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27
Q

Staph enterotoxins cause (blank) release in the intestine. Serotonin binds (blank) receptors on vagal afferent neurons and causes (blank)

A

5-hydroxytryptamine (serotonin)
5-hydroxytryptamine receptors
emesis

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28
Q

a 15 y/o man -> acute onset n/v and dirrhea shortly after returning from a party where he had potato salad. His symptoms started four hours after he ate it. He cant stop vomitting, he doesnt have a fever, no blood in vomit or stool. What do you think caused his symptoms?

A

Staph aureus

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29
Q

What is this:

no fever, diarrhea is present but without blood, and there are NO fecal leukocytes

A

Staph aureus induced food poisoning

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30
Q

(blank) is a gram positive aerobic rod. Outbreaks are relateively uncommon and are associated with many foods. FRIED RICE is leading cause of emetic food poisoning.

A

B. Cereus

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31
Q

What are the 2 food poisonings that B. cereus can cause?

A

Type 1
-orgnism grows in starchy foods (fried rice, potato, pasta, cheese)
-neurotoxin mediated emetic illness seen within 2-3 hours after ingestion
Type 2
-grows in meat, milk, vegetables, and fish
-produces heat-labile enterotoxin
-causes diarrhea within 10-12 hours after ingestion of toxin

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32
Q

A 28-year-old woman presents at the urgent care with an acute onset of crampy diffuse abdominal pain and multiple episodes of emesis that are nonbloody. She is afebrile, denies any diarrhea, and shows no signs of dehydration. When questioned further, the patient states that her last meal was 5 hours ago when she joined her friends for lunch at a local Chinese restaurant. She ate from the buffet, which included multiple poultry dishes and fried rice. You diagnose food poisoning most likely caused by (blank).

A

bacillus cereus

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33
Q

B. Cereus is often found in (blank) and mediated by a pre-formed (blank). What are the predominant symptoms?
Is therapy necessary?

A

fried rice
neurotoxin
n/v , non bloody diarrhea, no fecal leukocytes

no unless severe dehydration occurs

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34
Q

C. perfringens is a gram (blank), (blank) forming rod. What are the symptoms?
When do the symptoms occur?
The diarrhea generally lasts less than (blank)

A 
positive
spore
-abdominal cramping and watery diarrhea
-within 8-12 hours after ingestion of toxin
-24 hours
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35
Q

Clostridium perfringens produces (blank) that can survive cooking and grow to large numbers if the cooked food is held between 4°C and 60°C for an extensive amount of time

A

heat-resistant spores

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36
Q

What are the foods most frequently associated with clostridium perfringens?

A

meat and poultry dishes
sauces
gravies

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37
Q

(blank) binds to the brush border membrane in the small intestine and disrupts ion transport in the ileum and jejunum, altering (blank)

A

C. perfringens enterotoxin

membrane permeability.

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38
Q

Why does c. perfringens cause watery diarrhea?

A

-disruption of ion transport in ileum and jejunum altering membrane permeability. Excess amounts of ions and water enter the lumen and result in watery diarrhea

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39
Q

A 19-year-old man presents to the emergency department with 2 days of abdominal cramps, watery diarrhea, mild nausea, but no vomiting or fever. He has not traveled, but had dinner 3 days ago at a new Ethiopian restaurant where he ate an exotic meat dish. He is hydrated with IV fluid, given antiemetics, and discharged home after feeling much better. Two days later, the laboratory reports positive cultures for(blank)

A

Clostridium perfringens

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40
Q

Clostridial food poisoning results from eating contaminated (blank). What is the incubation period? How long is the clinical course?
Mediated by a (blank) that binds to receptors on brush border epithelia. Causes (blank and blank). Is fever and vomiting common?
Is therapy necessary?

A 
meat or meat products
one day incubation period
2 day clinical course
pre-formed heat labile enterotoxin
abdominal cramps and watery diarrhea
No
no, unless severe dehydration develops
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41
Q

C. botulinum intoxication is relatively (blank) with only (blank) cases of botulinism diagnosed yearly in the US

A

rare

15-40

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42
Q

Botulism causes death in approx. (blank) percent of / C botulinu, toxins produces symptoms of (blank) days after ingestion of improperly home-canned vegetables or sausage.

A

30%

1-2

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43
Q

Why does the botulism toxin have such a long incubation period?

A

because it has to spread from the intestine to nerve synapsesq

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44
Q

Botulinum toxin is a neurotoxin with (Blank) activity that cleaves a synaptosomal protein and prevents (Blank) of vesicles containing (Blank). Death is usually attributed to (blank)

A

metalloproteinase
exocytosis
acetylcholine
respiratory failure

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45
Q

What is this:
A 21-year-old university student had spent Thanksgiving day with relatives at her grandparent’s farm. During her drive back to campus on Friday morning her vision became blurry, and she was forced to pull over to the side of the road. As she sat in her car, her vision worsened. A highway patrol officer pulled over and approached her. By this time, she was having trouble swallowing and speaking clearly. He rushed her to the emergency room at a nearby hospital. In the ER, she was able to describe her symptoms to a physician, and to mention that her grandmother canned all of her own vegetables. The physician observed that her breathing was becoming labored, so her blood was sampled, her gastrointestinal tract pumped, and a mechanical respirator prepared for use.

A

Botulism

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46
Q

What are the intial symptoms of botulism?
Symptoms appear in (blank) days.
It is mediated by a pre-formed (Blank)
Botulism blocks (Blank) neurotransmission at the neuromuscular junction. Which results in (blank) and (blank)

A 
blurred vision
(fixed and dilated pupils, dry mouth, constipation and abdominal pain)
1-2 days
botulinum neurotoxin
cholinergic 
muscle weakness and flaccid paralysis
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47
Q

What is the only fatal food poisoning? How do you detect it?

A

botulism

culture or immunoassay

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48
Q

Presumptive diagnosis of botulism is determined by the presence of a (blank)

A

rapidly descending paralysis

a histoy of home-canned food or honey is helpful

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49
Q

What is the tx for toxemia due to S. aureus, B cereus, or C perfringens?

A

No treatment but if severe dehydration occurs then IV rehydration with fluids and electrolytes

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50
Q

Patients with susupected botulism should be admitted to an ICU to permit monitoring of (blank) and (blank) function.

A

respiratory and cardiac function

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51
Q

(blank) of botulism patient should be performed if exposure has occured within severelal hours. How can you prevent botulism?

A
  • Gastric lavage

- good personal hygiene and proper cooking and processing of food

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52
Q

How do you treat botulism?

A

-Trivalent (A,B,E) botulinum antitoin is administered to neutralize unabsorbed toxin in the bloodstream

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53
Q

Non-inflammatory gastroenteritis causes (blank) and results in large volume of (blank)

A

abdominal cramps

watery diarrhea

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54
Q

The bacteria that cause bacterial gastroenteritis colonize the surace of the (blank) but do not invade the (blank)

A

small intestine

mucosa

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55
Q

Viral causes of gastroenteritis infect (blank) and damage the (blank)

A

enterocytes

intestinal brush border

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56
Q

Viral and bacterial gastroenteritis are non-inflammatory diarrheas; fecal speciments do NOT contain any (blank)

A

fecal leukocytes

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57
Q

Viral gastroenteritis is caused by (blank x 4)

A

Norovirus
Rotavirus
Adenovirus
Astroviruses

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58
Q

(blank) are naked single stranded RNA-containing viruses in the Caliciviridae family (caliciviruses)

A

Norwalk (noroviruses)

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59
Q

What is the leading cause of outbreaks of gastroenteritis in the U.S?
Who does it primarily affect?

A

Norovirus (norwalk virus)

Older children and adults

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60
Q

Noroviruses are naked (blank) stranded (blank) containing viruses in the (blank) family

A

single
RNA
Caliciviridae

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61
Q

Gastroenteritis caused by norovirus infection is a highly (blank) syndrome and is often referred to as (blank) disease

A

seasonal

winter vomiting disease (“stomach flu”)

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62
Q

Noroviruses are found in the (blank or blank) of infected persons. Is it contagious?

A

stool or vomit

highly contagious and can spread rapidly via food, water, or fomites

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63
Q

An outbreak of a gastrointestinal illness occurs on a cruise ship. The affected passengers experienced 36 hours of vomiting and watery diarrhea. The patients were afebrile and blood and leukocytes were not observed in stool samples. Infected passengers were treated symptomatically to prevent dehydration, and the ship returned early from the cruise. Stored emesis and stool samples were tested by PCR, and (blank) was identified by public health officials. The ship was cleaned thoroughly with chlorine-containing products and reboarded with new passengers. Despite these decontamination efforts, the second group of passengers endures a similar outbreak.

A

norwalk

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64
Q

Norovirus infections are often seen in (blank) circumstances. What is an example of this?

A

crowded

cruises

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65
Q

What are the predominant symptoms of norovirus gastoenteritis?

A
  • N/V

- Watery diarrhea

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66
Q

What is the mean incubation period of the norovirus?
What is the mean duration of the illness?
Watch for evidence of (blank)

A

24-48 hours
12-60 hours
dehydration (dry mouth, skin tenting)

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67
Q

Non enveloped norovirus is extremely resistant to (blank)

A

decontamination

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68
Q

What is the most common cause of severe diarrhea and dehydration among children younger than 2 years of age?
What is the structure of rotavirus?

A

Rotavirus

Naked double-stranded RNA virus

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69
Q

When is the rotavirus most common?

A

winter

in adults, the disease tends to be mild

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70
Q

Where does the rotavirus replicate?

What is the most common mode of transmission?

A

intestine of most domestic and many wild animals

Fecal-oral route

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71
Q

Rotavirus attach and enter mature enterocytes at the tipes of (blank)

A

small intestinal villi

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72
Q

Does a rotavirus have an enterotoxin? What does it do?

A

yes-> NSP-4 enterotoxin

-induces Cl- and fluid secretion

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73
Q

What is this:
The patient was a 3-year-old male brought to the hospital by his parents in early December because of fever and dehydration. His parents reported that he had a 3-day history of fever, watery diarrhea, emesis, and decreased urine output. On admission his vital signs were temperature 39.5°C, pulse 126/min, respiratory rate 32/min, blood pressure 110/75. He was somnolent. Physical exam revealed only hyperactive bowel sounds. There were no leukocytes, or blood in the stool. Stool, blood, and urine cultures were negative for bacteria. A rapid enzyme immunoassay on the stool samples. The patient was given normal saline IV for rehydration and his emesis abated in 48 hours. He was discharged home.

A

rotavirus

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74
Q

What is the most common cause of gastroenteritis in children?

A

-rotavirus

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75
Q

What are the predominant symptoms of rotavirus?

A

n/v

watery diarrhea

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76
Q

What do you find in the stools of rotavirus?

How do you treat it?

A
  • absence of leukocytes and blood in stools
  • self-limiting, mild dehdyration can be handled by oral rehydration, severe dehydration can be handled by parenteral rehydration
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77
Q

T or F

Diagnostic tests usually are not performed to identify the causes of viral gastroenteritis

A

T

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78
Q

(blank) of stool, either by enzyme immunoassay or the latex agglutination test, can be used to aid in the diagnosis of rotavirus infection

A

Rapid antigen test

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79
Q

What are the 2 highly effective rotavirus vaccines?

When do you give them?

A

RotaTeq and Rotarix

2,4, and 6 months of age

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80
Q

Persons who are infected with norovirus should not (blank) while they are symptomatic and for 3 days after they recover from the illness

A

prepare food

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81
Q

(blank) is the most common cause of traveler’s diarrhea resulting in 50 million cases, mainly in developing countries

A

E. coli

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82
Q

E. coli gastroenteritis is a common malady of people traveling outside of the US. It is caused by 3 different pathotypes of E. coli, what are they?

A
  • Enterotoxigenic E. coli (ETEC)
  • Enteroaggregative E. coli (EAEC)
  • Enteropathogenic E. coli (EPEC)
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83
Q

(blank) can also cause diarrhea in infants.

(blank) thus far has been incriminated only in mild diarrheal disease in infants primarily younger than 6 months of age.

A

ETEC

EPEC

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84
Q

(blank) strains colonize the small intestine and produces 2 entertoxins called (blank) and (blank)

A

(LT) Heat labile toxin

(ST) Heat stable toxin

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85
Q

LT and ST (from enterotoxigenic E coli toxin) ultimately stimulates the secretion of (blank) by host cells, which results in (blank)

A

Cl-

watery diarrhea

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86
Q

LT is an (blank) toxin similiar to the cholera toxin.

What does it do?

A

A-B toxin

adenosine diphosphate ribosylates a GTP-binding protein resulting in increased intracellular levels of cAMP which stimulates chloride and water secretion

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87
Q

What does ST do?

A

causes increases in intracellular cGMP, which ultimately stimulates chloride ion secretion, leading to an osmotic diarrhea

88
Q

A 21-year-old woman presents with the complaint of diarrhea. She returned from Mexico the day before her visit. The day before that, she had an acute onset of profuse watery diarrhea. She denies blood or mucus in the stools. She has had no associated fever, chills, nausea, or vomiting. She has no other medical problems and is taking no medications. Examination is remarkable for diffuse, mild abdominal tenderness to palpation without guarding or rebound tenderness. Stool is guaiac negative. (blank) is suspected as it is the most common cause of traveler’s diarrhea in Mexico.

A

Enterotoxigenic Escherichia coli

89
Q

(blank) is the most common cause of traveler’s diarrhea (particularly in Mexico).
Profuse and watery suggests a (blank) site of infection.
Absence of bloody stool makes inflammatory diarrhea less likely
Diarrhea results from the production of a (blank) and (blank) enterotoxins
In most casessymptoms are self-limited
Preventing dehydration is essential, and persistent or particularly severe cases may be treated with antibiotics

A

Enterotoxigenic E. coli (ETEC)
small bowel
heat-labile and a heat-stable

90
Q

E. coli gastroenteritis is usually a (Blank) disease and diagnosis is usually determined on clinical grounds

A

self-limiting

91
Q

How do you diagnose ETEC?

A

stool culture on MacConkey agar, assaying for the toxins by immunoassay or toxin genes with a DNA probe

92
Q

How do you treat gastroenteritis caused by E. coli? What if antibiotics are needed?

A
  • oral replacement of fluid and electrolytes lost in feces

- Ciprofloxacin or levofloxacin, Rifaximin

93
Q

(Blank) is approved for the tx of traveler’s diarrhea caused by noninvasive strains of E. coli

A

Rifaximin

94
Q

(blank) may provide symptomatic relief, with less severe abdominal cramps and less frequent stools in E. coli gastroenteritis

A

Bismuth subsalicylate

95
Q

(blank) is a slightly curved gram-negative rod that is ingested with water or food

A

Vibrio cholerae

96
Q

Vibrio cholerae causes acute illness due to an (blank) enterotoxin elaborated by microbes that have colonized the (Blank)

A

A-B enterotoxin

small bowel

97
Q

Vibrio cholerae in its most severe form has a rapid loss of (blank and blank) from the GI tract resulting in (blanK X 3)

A

liquid and electrolytes

hypovolemic shock, metabolic acidosis, death

98
Q

Vibrio Cholera produces (blank) serogroups based on (blank). Which serogroups produce cholera toxin?

A

140
LPS
01-0139

99
Q

V. cholerae is a(blank) sensitive, and most ingested organisms are killed by (blank).
(blank) bacterial cells must be ingested to cause disease.

A

acid
stomach acidity

10^8 - 10^10

100
Q

V. cholerae attaches to the microvilli of the (blank and blank), where they multiply and liberate (blank), (blank) and (blank).
Do they invade the mucosa?

A

jejunum and ileum
cholera enterotxin, mucinase, endotoxin

NO

101
Q

Cholera enterotoxin (Blank) and causes a sustained increase in adenylate cyclase activity, increases (bank) and increase net (blank)

A

ADP-ribosylates GTP-binding proteins
cyclic AMP
net fluid secretion

102
Q

All the signs, symptoms and metabolic derangements from V. cholerae results from (blank).
What other species of Vibrio cause gastroenteritis?

A

rapid loss of liquid from the small inestine

-Vibrio parahaemolyticus and V. vulnificus

103
Q

A 57-year-old man was hospitalized in New York with a 2-day history of severe, watery diarrhea and vomiting. The illness had begun 1 day after his return from Ecuador. The patient was dehydrated and suffering from an electrolyte imbalance (acidosis, hypokalemia). He recalled having oysters on the half shell the last night of his trip. The patient made an uneventful recovery after fluid and electrolyte replacement was instituted to compensate for the losses resulting from the watery diarrhea. Stool cultures on TCBS agar were positive for (blank)

A

Vibrio cholerae.

104
Q

Cholera presents with an abrupt onset of (blank) and (blank). It can rapdily progress to (bank). What are the lab values like?

A

watery diarrhea (RICE water stools) and vomiting

severe dehydration

Metabolic acidosis, hypokalemia, hypovolemic shock

105
Q

V. cholera is associated with recent consumption of (blank) or (blank). How do you treat it?

A

water
contaminated seafood

oral or IV rehydration
Azithromycin (severe cases)

106
Q

how do you typically diagnose V. cholera?

A
  • Clinical presentation and rice water stools

- Definitive diagnosis by plating a fecal sample on TCBS agar

107
Q

What type of agar is selective for V. cholera?

A

thiosulfatecritrate-bile salt-sucrose (TCBS)

108
Q

What 2 antibiotics are used to reduce the severity and length of disease caused by v. cholera?

A

azithromycin or doxycycline

109
Q

(blank) is a flagellated protozoan with a trophozite (growing form) and a cyst (environmental resistant from)

A

Giardia lamblia

110
Q

(blank) is the most common intestinal protozoan parasite of humans in the U.S.
Where in the body does it live?
How do you get it?
Where is it cmmonly seen?

A

Giardiasis
small intestines (of humans and animals)
water containing G. lamblia infectious cysts
Day care centers w/ fecal-oral transmission

111
Q

A 24-year-old female medical student from Reno presents to the urgent care with crampy abdominal pain, flatulence, and a watery, foul-smelling diarrhea that has worsened over 3 days. She is an avid hiker and reported several recent hikes up Hunter Creek canyon to look at the mountain beaver dams. On the last hike 10 days ago she forgot her water purifier and drank creek water. Stool examination shows small cysts containing four nuclei, and stool antigen immunoassay is positive for(blank). She was treated with metronidazole (Flagyl) and made an uneventful recovery.

A

Giardialamblia.

112
Q

How long is the incubation period of G. lamblia?

What do mild infections present with?

What can chronic infections lead to?

Spontaneous recovery usually occurs in (blank) days?

How is it treated?

A

10 day incubation period

  • crampy abdominal pain and smelly, watery diarrhea (no blood), flatulence and steatorrhea
  • malabsorption
  • 10-14 days
  • metronidazole or nitazoxinide
113
Q

How do you diagnose G. lamblia?

A

presumptive- H and P
confirmative
-Trophozoites or cysts in feces for 3 days
-Entero-test (string test, sample of duodenum)

114
Q

How do you prevent G. lamblia?
How do you treat it?
Will chlorination kill it?

A
  • boil or filter water on outdoor trips
  • metronidazole or nitazoxinide
  • No!!! need filtration system
115
Q

(blank) is a coccidian parasite. Occurs worldwide and inhabits the (blank) of a variety of animals, fish, mammals and reptiles and is a common contaminant in water.

A

Cryptosporidium parvum

116
Q

Ingestions of (blank) in immunocompromised persons is more likely to result in persistent chronic diarrhea

A

Cryptosporidium parvum oocysts

117
Q

Only (blank) can cause diarrhea in humans. Who is this common in?
How is it transmitted?

A

150 oocysts of cryptosporidium parum
-daycare centeres and among male homosexuals

-autoinfections and person-to-person (fecal-oral and anal-oral) is common

118
Q

What is this:
A 28-year-old woman is brought to the hospital because of abdominal pain, weight loss, and dehydration. She has been diagnosed with HIV for the past 2 years with a history of oral candidiasis and pneumocystis pneumonia. She reports voluminous watery diarrhea over the past 2 weeks. Because of medical non-compliance, she has not taken any antiretroviral therapy. Stool samples were concentrated by flotation and stained with an acid-fast stain. (A). With no anti-parasite drug available, she is told to start and continue her anti-retroviral therapy

A

Oocysts of Cryptosporidium parvum were identified

119
Q

What indicates severe and chronic diarrhea in HIV-infected patients caused by cryptosporidium parvum?
Fluid loss can exceed (blank) L/day/

A

50> stools a day for months to a year

15

120
Q

The cryptosporidium parvum parasite affects (blank) and causes inflammatory damage of the (blank) and malabsorption of the (blank)

A

ion transport
microvilli
small intestine

121
Q

The cysts of C. parvum are (blank) positive, a stool smear stained with (blank) can be used to visualize the parasites. Infection is usually (blank) in persons with normal immune functioning and doesnt require medication

A

acid fast positive
Kinyoun acid-fast stain
Self limiting

122
Q

Immunocompetent children and adults with C. parvum can be treated with (blank). Immunocompromised indiviuals respond poorly to anti-parasite agents. Nonspecific (Blank) agents may provide temporary relief for patients where the infection will resolve w/out antiparasitic tx.
(blank) sources should be avoided

A

nitazoxanide
antidiarrheal agents
contaminated water

123
Q

What diseases are considered inflammatory enterocolitis?

A
  • pseudomembranous colitis
  • bacterial dysentery
  • amebiasis (parasitic dysentery)
124
Q

What are all the bacteria that cause bacterial dysentery?

A 
Campylobacteriosis
E. coli dysentary
Shigellosis
Salmonellosis
Versiniosis
125
Q

In inflammatory enterocolitis, the infections occur primarily in the (blank) and (blank) and can invade the surrounding tissues.
Invasion of the intestine can result in (blank) in feces and cause and inflammatory response (leukocytosis)

A

distal small intestine
colon
blood in feces

126
Q

Clostridium difficile is an (blank) gram (bank) spore forming rod.
What does C diff cause?
What toxins does it produce?

A

anaerobic
gram positive
Diarrhea or pseudomembraneous colitis
Toxin A and B

127
Q

Toxin A from C Diff is a (blank) toxin

Toxin B from C diff is a (blank) toxin

A

Enterotoxin

Cytotoxin

128
Q

Pseudomembraneous colitis usually occurs after (blank) tx. You get (bank) mediated destruction of colonic epithelium with (blank) formation

A

long-term antibiotic (often nosocomial)
toxin
pseudomembrane

129
Q

An 78-year-old white woman was readmitted to the hospital because of recurrent pneumonia. Ten days earlier, she had been treated at another institution. She had been treated with amoxicillin for right lower lobe pneumonia. Upon readmission she was febrile and her WBC count was 36,000 per mm3. She had lower abdominal pain and passed several loose bloody, stools. In light of the patient’s recent history of antibiotic use,(blank)-associated diarrhea was considered, and a stool sample was obtained for analysis. It was positive for C. difficile toxin A, and sigmoidoscopy confirmed pseudomembranous colitis (A). The other antibiotics were stopped and she was started on (blank)

A

Clostridium difficile

metronidazole.

130
Q

What is this:
patient with bloody diarrhea and hx of antibiotic use, abdominal pain, low grade fever and leukocytosis

What is the most common antibiotic implicated?

What do the c. difficule toxins do?

A

C diff

Clindamycin, cephalosporins, ampicillin and amoxicillin

dimerize actin filaments and make shallow ulcers

131
Q

What causes pus and mucus formation resulting in a pseduomembrane formation?
What are the complications?

A

C. diff

toxic megacolon and bowel perforation

132
Q

How do you diagnose C. Diff?

A

-sigmoidoscopy can identify pseudomembranes

133
Q

How do you treat C. diff?

A

withdrawal of the antibiotic and replacement of intestinal flora. Rehydrate patient.
-Metronidazole or vanomycin

134
Q

How do you treat a patient with toxic megacolon?

A

surgically, bowel resection or ileostomy

135
Q

Why dont you use antimotility drugs for c. diff patients?

A

-Because they increase the likelihood of full-blown colitis and toxic megacolon

136
Q

Bacterial dysentary principally involves the (blank)

A

large intestine

137
Q

Organisms that cause bacterial dysentary include (blank x 4)

Are these aggressive?

A 
Campylobacter jejuni
Shigella spp
Salmonella spp
Yersinia enterocolitica
E. coli

yes-> mounts an inflammatory response

138
Q

What is this:
small stool volume that contains mucus and leukocytes; if invasion is deep enough, the stool can be bloody. Fever and abdominal pain. Pain while deficating (tenesmus)

A

Bacterial dysentary

139
Q

Campylobacter jejuni are (immotile/motile), gram-(negative/positive) S-shaped or gull wing-shaped rods that commonly occur in pairs and are microaerophilic

A

motile

gram-negative

140
Q

What is the leading cause of bacterial diarrheal illness in the US?

A

C. jejuni

141
Q

(blank) is in undercookied or raw met, unpasteruized milk and nonchlorinated contaminated water

A

C. jejuni

142
Q

Most chicke mean sold in retail food markets is contaminated with (blank)

A

C. jejuni

143
Q

A previously healthy 32-year-old man describes 1 to 2 days of fever, myalgia, and headache followed by abdominal pain and diarrhea. He has experienced up to 10 bowel movements over the past day. He has noted mucus and blood in the stool. The patient notes that 3 days ago, he was at a church picnic where he ate barbeque chicken. He has not traveled in more than 6 months. Physical examination is unremarkable except for a temperature of 38.8°C and diffuse abdominal tenderness. Wright’s stain of a fecal sample reveals the presence of neutrophils. Colonoscopy reveals inflamed mucosa. Fecal culture on Skirrow agar under microaerophilic conditions at 42°C reveals colonies of gram-negative, motile, S-shaped rods. The diagnosis is (blank)

A

campylobacter jejuni

144
Q

What is thisL
malaise, fever, abdominal cramps, tenesmus, bloody stool, fecal leukocytes

Some strains produce (blank) toxin. What does this toxin do?

A

C. jejuni

Shiga toxin
potent protein synthesis inhibitor

145
Q

C jejuni will kill host cells and form (blank) in the bowel mucosa

A

superficial ulcers

146
Q

How do you diagnose C. jejuni?

A

gull wing-shaped bacteria
watery, bloody, leukocyte filled feces,
darting motility

147
Q

how do you treat C. jejuni?

What shoud you be worried about?

A

oral rehydration
Azithromycin
Ciprofloxacin

Post Campylobacteri guillain barre and reactive arthritis

148
Q

How do you prevent C. jejuni?

A

properly cooking chicken
pasteurizing milk
chlorinating drinking water

149
Q

(blank) and (blank) pathotypes have acquired shiga toxin, which causes cell death, edema and hemorrhage in the LP,

A

EHEC

EIEC

150
Q

(blank) can live in the intestines of healthy cattle; meat can be contaminated during slaughter

A

EHEC

151
Q

The shiga toxin in kidneys can cause (blank).

A

HUS (hemolytic uremic syndrome)

152
Q

What is the most common cause of hemorrhagi colitis and HUS? What protocol do you follow if you have this?

A

EHEC serotype 0157:H7

Report it to the state health department

153
Q

A 25-year-old, previously healthy woman came to the emergency room for the evaluation of bloody diarrhea and diffuse abdominal pain of 24 hours duration. She complained of nausea and had vomited twice. She reported no history of inflammatory bowel disease, previous diarrhea, or contact with other people with diarrhea. The symptoms began 24 hours after she had eaten an undercooked hamburger at a local fast food restaurant. Rectal examination revealed watery stool with gross blood. Sigmoidoscopy showed diffuse mucosal erythema and petechiae with a modest exudation but no ulceration or pseudomembranes. Growth on MacConkey medium confirms diagnosis of enterhemorrhagic (blank) infection.

A

Escherichia coli

154
Q

What is e. coi infection mediated by?

What agar does it grow on?

A

shiga toxins

MacConkey medium

155
Q

Physicians and state epidemiologists investigate a cluster of acute diarrheal cases in children who attend a preschool in a small Midwestern town. The children presented with fever, acute episodes of bloody diarrhea, and petechial rash or purpura. Two of the children have scanty urine output and are showing signs renal failure (azotemia). Both have leukocytosis (>20,000/mm3). They are anemic and show schistocytes on peripheral blood films. Shiga toxin is identified in stools by immunoassay, and stool cultures on MacConkey/Sorbitol agar indicate enterohemorrhagic Escherichia coli (EHEC). The two children are diagnosed with (blank)

A

hemolytic uremic syndrome (HUS).

156
Q

(blank) infection is the primary cause of HUS and a leading cause of renal insufficiency in children. Occurs in (blank) of individuals during EHEC outbreaks.
It begins with (blank) and is often heralded by high (blank)

A

EHEC
5-10%
hemorrhagic colitis
leukocytosis

157
Q

WHo are at risk for E coli dysentary?

A

Children less than five and elderly

158
Q

(blank) is a microangiopathic hemolytic anemia marked by the appearance of thrombocytopenia, schistocytes and aztomeia

A

HUS

159
Q

How do you diagnose E coli dysentary?

Gram negative, lactose fermenting EHEC 0157:H7 bacilli needs (Blank) on (blank) agar

A

-isolation and identification of etiologic agent

carb sorbitol
MacConkey medium

160
Q

Admin of antibiotics in shiga toxin bearing EHEC and EIEC kills the bacteria and releases additional toxin increasing the likelihood that the patient will develop (blank).
Should you give antimotility drugs or antibiotics for E coli dysentary?
How do you prevent this?

A

HUS
NO!!!!

Drink potable water and properly cooked food, and drink pasteurized fruit juices

161
Q

Shigella are (motile/non motile), (blank) fermenting, gram (positive/negative) rods that are closely related to e. coli

A

motile
lactose
negative

162
Q

Shigellosis is found in (blank). It is primarily a (blank) disease in the US. It has highly efficient transmission by the (blank) route. What is considered an infecting dose?

A

ONLY HUMANS!!!!
pediatric
fecal-oral route
10 organisms

163
Q

Shigella is also spread by food or water contaminated by humans. The secondary attack rates among family members are as high as (blank)

A

40%.

164
Q

(blank) is more common in closed pop groups in substandard sanitation. It is a (blank) producing bacteria that infects the colon epithelial cells and inhibits protein synthesis.

A

Shigellosis

Shiga-toxin

165
Q

How do patients with shigellosis present?

A

fever, ab pain, diarrhea that becomes dystentary and then dehydration

166
Q

What signs help you diagnose shigellosis?

What gives you the definitive diagnosis?

A
  • stool containing white blood cell
  • lactoferrin positive
  • shallow colonic ulcers
  • microabscess in rectal bopsy

-culture of shigella from feces on selective media and biochem tests

167
Q

What agar does shigella grow on?

A

Hektoen enteric or S-S agar

168
Q

How do you treat shigellosis?

A

fluid and electrolyte replacement

strict sanitary food prep and personal hygiene needed avoid acquiring shigellosis

169
Q

Do you use antidiarrheal compounds in shigellosis?

A

nO! ( you do not want to inhibit peristalsis)

170
Q

Salmonelle are (immotile, motile) lactose (fermenting/non fermenting) gram (positive/negative) that produced (blank)

A

motile
non fermenting
negative
Hydrogen sulfide (H2S)

171
Q

Most human disease causing salmonella are in the genus/species called (blank)

A

salmonella enterica

172
Q

Many serovars of S. enterica causes (blank), the most common form of disease is due to (blank). What are other serovars fo S. enterica and what do they invade?

A

enteritis
salmonella

Typhi and paratyphi A-> enteric or typhoid fevers

173
Q

Salmonella are commonly found inhabiting the intestines of (blank X 4). strains that cause typhoid are strictly (blank)

A

chickens, reptiles, birds, and humans

human

174
Q

Some humans infected with these typhoid-causing organisms become chronic carriers that transmit infections via (blank) route

A

fecal-oral route (typhoid mary)

175
Q

Transmission of salmonela is common from animals to humans (zoonotic disease) and from (blank) products to humans

A

animal food products

176
Q

(blank) is the most common form of salmonellosis.
(blank) products are common sources.
Patients present with (blank X 4)
Invades (blank) and multiples in (blank) in lymph follicles.

A 
Enterocolitis
eggs, poultry and dairy produts
non-bloody diarrhea, fever, myalgias, and ab cramps
intestinal mucosa
macrophages
177
Q

Salmonelle enters the (Blank) lymph nodes to blood and dissemination. Symptoms appear about (blank) hours after ingestion of contaminated food or water; resolves spontaneously.
Infective dose is high (greater than 10^6) because of stomach acid, reduced (Blank) increases susceptibility.

A

mesenteric
24-48 hrs
gastric acidity

178
Q

What is this:
A 37-year-old man presented with a 2 day history of abdominal cramps, diarrhea, nausea, and vomiting. His vital signs are normal except for a low grade fever. One day prior to the onset of symptoms, he had visited his grandmother who prepared soft-boiled eggs for breakfast. His clinical history reveals gastroesophageal reflux disease for which he regularly takes antacids. Examination of a fecal smear from the patient revealed abundant fecal leukocytes. Fecal culture reveals lactose non-fermenting bacteria.

A

salmonella enterocolitis

179
Q

Enteric fevers are caused by (blank and blank
About (blank) days after ingestions, patients experience a gradually increasing (blank) with (blank x 4).
The symptoms persist for about (blank), this is called the bacteremic phase.
Colonization of the (blank) then reinfection of the intestines with (blank)

A 
S. typhi, S. paratyphi
10-14 days
fevere, H/A, myalgias, malaise, anorexia
gallbladder
diarrhea
180
Q

(blank) can cause skin lesions called (blank)

A

rose spots

181
Q

A 20-year-old male is brought to the emergency department with a 1-day history of delirium. He has had a sustained fever of up to 40°C and a history of progressive headache, myalgia, and constipation which began 10 days previously as he was returning to the United States from a trip to visit relatives in India. Physical examination revealed hepatosplenomegaly, diffuse abdominal tenderness, and red spots on the chest and neck. Colonies of a Gram-negative bacillus that produced a characteristic “fish-eye” growth (lactose nonfermenter with sulfur reduction) are isolated on Hektoen agar (A) from blood and stool samples as shown in the photograph. The diagnosis is typhoid fever caused by (blank)

A

Salmonella Typhi.

182
Q

Isolation of salmonella from a fecal sample using ( blank) or (blank) agar followed bybiohemical identification with (blank) is necessary for definitive diagnosis

A

Hektoen or S-S agar

AP12OE

183
Q

Salmonella enterocolitis is (blank) in most people; antibiotics prolong carriage and are usually (blank). (blank) replacement is necessary in severe cases. DO you use antidiarrheal compounds?
Patients with enteric fevers warrant immediate (blank)

A 
self-limiting
contraindicated
Fluid and electrolyte replacement
NO
antibiotic therapy (e.g ciprofloxacin or ceftriaxone)
184
Q

What are the 2 typhoid vccines?

A

oral live attenuated vaccine

VI capsular polysaccharide vaccine that is injected

185
Q

Yersinia enterocoliticais a gram-(blank) member of the family (blank); it is a zoonotic disease
It can cause an (blank)-like illness, (blank) (which may mimic acute appendicitis), or an inflammatory ileitis or ulcerative colitis syndrome
Most cases can be traced to consumption of contaminated (blank x 3)

A 
negative 
Enterobacteriaceae
enteric fever-like illness
mesenteric adenitis 
meat, milk, or water
186
Q

The virulence ofYersiniais associated with the direct injection of proteins, such as(blank and blank), into eukaryotic cells

A

Yersiniaprotein kinase A (YpkA) and YopE

187
Q

Yersiniainfection may also be associated with (blank x 3)

A

migratory polyarthritis, Reiter’s syndrome, or erythema nodosum

188
Q

A 7-year-old boy presents to the emergency department with fever, abdominal pain, and tenderness in the right lower quadrant. A white blood cell count reveals leukocytosis. Suspecting appendicitis, the child is taken to surgery; however, the removed appendix is grossly and histologically normal. A Gram-negative rod was identified after cold enrichment of fecal cultures on CIN agar. The isolate was confirmed to be (blank) by PCR.

A

Yersinia enterocolitica

189
Q

Yersiniosis can cause (blank) which mimics appendicitis

How can you diagnose it?

A

mesenteric adenitis

cold enrichment techniques and PCR methods (sensitive)

190
Q

Yersinia infection is usually (blank). Severe illness or systemic infection are treated with (blank and blank)

A

self-limiting

doxycycline and tobramycin

191
Q

What is the xTAG GI pathogen panel?

A 
detects 7 bacterial pathogens (c. jejuni, c. diff, 3 forms of e. coli, salmonella, shigella)
2 viruses (norovirus, rotavius A)
2 parasites (cryptosporidium and giardia)
192
Q

E. histolytica is a protozoan parasite found worldwide and causes (blank), relatively uncommon in the US. The motile amoeboid (blank) is the only form present in tissue; the (blank) form is the infectious form of the parasite

A

dysentary
trophozoite
cyst

193
Q

Who are the high risk groups for getting E. histolytica?

A
  • male homosexuals
  • travelers ouside US
  • recent immigrants
  • institutionalized pop (prison inmates)
194
Q

What is the most common site of extraintestinal amebic disease caused by e histolytica?

A

Liver

195
Q

Amebiasis is transmitted by (blank) of drinking water and foods but also can be transmitted by (blank) with fecally contaminated hands or objects as well as by sexual contact.

A

fecal contamination

direct contact

196
Q

A 31-year-old immigrant from Mexico presents with lower quadrant abdominal tenderness of a month duration. He has recently noted diarrhea with blood and mucous in his stool. His vital signs are temperature 38° C, heart rate 78, respirations 18, and blood pressure 128/78. On physical exam he has abdominal pain, distention, and rebound tenderness. Given the duration of his illness and symptoms, you suspect amebic colitis and order fecal leukocytes, and a trichrome stain. There are very few leukocytes. The antigen test is positive, and microscopy reveals trophozoites with ingested RBC (A). What is the patient diagnosed with?

A

Entamoeba histolytica

197
Q

E. histolytic releases (blank) that destroys leukocytes, and have (blank) shaped ulcers. How do you treat this/

A

cytotoxins
flask shaped ulcer
metronidazole, tinidazole, iodoquinol

198
Q

What is this:
A 45-year-old migrant worker originally from Guatemala is evaluated for right upper quadrant pain, fever, and hepatic tenderness. He has had nausea and vomiting, but no diarrhea. Of note, he has been in the United States for approximately 10 months and was well until approximately 8 days ago. He reports a weight loss of 20 lbs. CBC reveals leukocytosis. He is found to have a large hepatic abscess on CT scan of the abdomen

A

E. histolytica

199
Q

(blank) is the most frequent extraintestinal manifestation of Entamoeba histolyticainfection

A

Amebic liver abscess

200
Q

How do you diagnose E. histolytica?

IF the cytoplasm of the trophozoite contains (blank), the diagoses of amebiasis is definitive

A

trophozoites or cysts in feces or trophozoites in tissues obtained from lesions

red blood cells

201
Q

(blank) without eosinphilia is common in e. histolytica

What are ways you can diagnose E histolytica?

A

leukocytosis

  • immunoassays for feces
  • serology for extraintestinl infections
  • CHest x ray, CT, MRI extraintestinal amebic abscesses
202
Q

In E. Histolytica, what will you aspirate?

A

a brown anchovy paste-like material is often aspirated from liver abscesses

203
Q

Asymptomatic intestinal E. histolytica infections can be treated with (blank) or (blank).

Mild to moderate extraintestinal disease that includes diarrhea or dysentery can be treated with (Blank or blank) followed by either (blank or blank)

A

iodoquinol or paromomycin

tinidazole or metronidazole

paromomycin or iodoquinol

204
Q

Only large liver abscesses should be treated (blank)

A

surgically

205
Q

What are the helminithic parasites that cause GI infections?

Where do they lay their eggs and what do these mean eggs do?

A

Schistosoma mansoni and S. Japonicum flukes
-mesenteric veins
fever, malaise, ab pain, liver tenderness.

206
Q

Chronic deposition of schistosoma eggs in the bowel mucosa results in inflammation and (blank) of the bowel wall with associated (blank X 3)

A

thickening

ab pain, diarrhea and blood in the stool

207
Q

(blank) in the small intestine produce the gastrointestinal symptoms of nausea, vomiting, and diarrhea with copious amounts of blood. As blood is lost from feeding worms, a microcytic hypochromic anemia develops (>1 billion cases)

A

Adult hookworms (Ancylostoma duodenale and Necator americanus)

208
Q

Intestinal infections with many (blank) larvae may produce abdominal pain and distention, bloody diarrhea, weakness, and weight loss. Anema is seen in severe infections (>1 billion cases)

A

Trichiuris trichirua (whipworm)

209
Q

Intestinal infections with large (blank) worm burdens can affect the entire small bowel and the colon. Inflammation and ulceration causes epigastric pain and tenderness, vomiting, diarrhea (occasionally bloody), and malabsorption (>200 million cases)

A

Strongyloides stercoralis

210
Q

(blank) can cause abdominal pain and tenderness, tenesmus, nausea, anorexia, and watery stools with blood and pus. Ulceration of the intestinal mucosa, as with amebiasis, can been seen

A

Balantidium coli

211
Q

(blank) infections cause mild nausea, anorexia, abdominal cramping, and watery diarrhea. Fatigue, malaise, flatulence, and bloating has also been reported. Similar in presentation to cryptosporidiosis

A

Cyclospora spp.

212
Q

(blank) infected patients may be asymptomatic, or suffer mild to severe gastrointestinal disease. Disease most commonly mimics giardiasis, with a malabsorption syndrome characterized by loose, foul-smelling stools

A

Isospora belli

213
Q

(blank) can colonize the cecum and colon. Some patients may develop symptomatic disease with abdominal discomfort, flatulence, intermittent diarrhea, anorexia, and weight loss

A

Dientamoeba fragilis

214
Q

A 62-yr-old female patient who lived in a local rural village in Guatemala had suffered from severe chronic anemia for several years. She was transferred to a hospital in Guatemala City for management of severe dyspnea and dizziness. At admission, she showed symptoms or signs of severe anemia. Stool examination revealed the presence of hookworm eggs\
What is this?

A

Necator Americansu

215
Q

Early hookworm disease may present with (blank) lesions and (blank). Chronic disease presents with (blank) in the stools and signs of (blank). Protracted infections cause (blank) in children. How do you treat it?

A

cutaneous lesions and pneumonitis
Blood in the stools and signs of anemia
Developmental delay
Albendazole and iron supplementation

Block 10 week 5 (3 decks)

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