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Case 8: GIT diarrhoea > GIT infections (bacteria) > Flashcards

GIT infections (bacteria) Flashcards

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1
Q

What 5 bacteria does the normal gut flora not contain

A

Salmonella
Shingella
Campylobacter.
Vibrio
Yersinia species

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2
Q

What micro-organisms does the normal gut flora contain

A

Bacteria: enterococci & coliforms (E.Coli & Klebsiella spp)
Protozoa: Entamoeba coli
Fungi: Candida species

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3
Q

What is the 5 functions of the normal gut flora

A
  1. Fermenting unused energy substrates
  2. Stimulating the immune system
  3. Preventing growth of harmful pathogenic bacteria
  4. Producing vitamin for the host
  5. Protection against infection
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4
Q

What is the 6 mechanisms of protection in the GIT

A
  1. Acidic pH of stomach
  2. Antibacterial activity of enzymes & bile
  3. Normal gut flora
  4. Loss of epithelial cells
  5. Peristalsis
  6. Antibodies
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5
Q

What is the 6 micro-organisms causing dysentery

A

Salmonella
E Coli
Entamoeba
Campylobacter
Shigella
Yersinia Enterocolitica

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6
Q

What micro-organism is associated w/ pregnancy

A

Listeria

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7
Q

What micro-organisms cause rice water stool

A

V. Cholerae

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8
Q

What is the 2 most common cause of travellers bacteria

A

E. Coli & Shingella

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9
Q

Define food intoxication

A

Ingestion of preformed toxins

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10
Q

Define food infection

A

Food contaminated w/ micro-organisms

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11
Q

What micro organisms group is the most common cause of food poisoning

A

Virusses

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12
Q

What is seen as a food poisoning outbreak

A

2 or more people at the same time

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13
Q

What is the symptoms caused by food poisoning

A

Diarrhoea, nausea, vomiting, abdominal pain, malaise & cramps

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14
Q

What is the two food poisoning syndromes & their causes

A
  1. Short incubation: nausea & vomiting (upper GIT) w/i 1-6 hrs caused by S aureus & Bacillus cereus
  2. Long incubation: abdominal cramps & diarrhoea (lower GIT) w/i 8-16 hrs caused by C perfringens & B Cereus
    if neurological symptoms think C Botulinum
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15
Q

Describe V. Cholerae morphology, source of infection, symptoms & complications, treatment & diagnosis

A

Morphology:
Curved gram - bacilli that is C shaped
Pili for adherence & toxin production
Incubation period of 2 days
Source of infection:
Untreated water w/ low infectivity
Symptoms & complications:
Severe water/rice diarrhoea
Severe dehydration & death
Treatment:
Oral/IV fluid & electrolyte replacement
Severe: antibiotic (doxycycline & ciprofloxin)
Diagosis:
Stool culture & outbreak

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16
Q

Describe Campylobacter morphology, source of infection, symptoms & complications & treatment

A

Morphology:
Curved gram - bacilli that is seagull shaped
Incubation period of 1-7 days
Source of infection:
Food borne & high infectivity
Symptoms & complications:
Severe abdominal pain, fever & dysentry
Gillian Barre syndrome (Ab that cross reactive w/ myelin)
Treatment:
Oral/IV fluid & electrolyte replacement
Severe: antibiotic

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17
Q

Describe Listeria monocytogenes morphology, source of infection, symptoms & complications & treatment

A

Morphology:
Intracellular anaerobic bacteria
B-haemolytic
Source of infection:
Foodborne from meat fairy & vegetables
Symptoms & complications:
Asymptomatic & self limiting or invasive dysentery causing bacteraemia & meningitis (especially elderly, children, immunocompromised & pregnant)
Treatment:
Oral/IV fluid & electrolyte replacement

18
Q

Describe E. Coli morphology, source of infection, symptoms & complications & treatment

A

Morphology:
Pili to attach & invade
Produce toxins
Source of infection:
Foodborne & highly infectivity
Symptoms & complications:
Haemolytic anaemia syndrome: renal failure, anaemia & thrombocytopenia
Can lead to haemorrhagic colitis
Treatment:
Oral/IV fluid & electrolyte replacement

19
Q

What is the 5 Pathogenesis of E. coli & their cause

A

EnteroPathogenic E.Coli causing watery stool
EnteroInvasie E. Coli causing dysentery
EnteroToxigenic E. Coli causing watery stool
EnteroHaemorrhgaic E. Coli causing dysentery
EnteroAdherent E.Coli causing watery stool

20
Q

What is the local & systemic complications of diarrhoea

A

Local: intestinal wall perforation & vessel erosion
Systemic: hypovolaemia, septic shock & malnutrition

21
Q

Describe Shingella morphology, source of infection, symptoms & complications & treatment

A

Morphology:
Invade colon w/ inflammation & mucosal ulcers & abscess formation
Acid resistant & toxin
Source of infection:
Unsanitary condition w/ high infectivity (human reservoir)
Symptoms & complications:
Initially watery diarrhoea then dysentery
Cramps, tenesmus
Treatment:
Oral/IV fluid & electrolyte replacement
Antibiotic decrease severity & duration

22
Q

Describe non-typhoid salmonella source of infection, symptoms & complications, treatment, prevention & diagnosis

A

Source of infection:
Faeco-oral transmission & poultry w/ low infectivity
Symptoms & complications:
Fever, vomiting, dysentery causing gastroenteritis
Bacteraemia & metastatic infection in immunocompromised
Treatment:
Oral/IV fluid & electrolyte replacement in gastroenteritis
Immunocompromised antibiotics ceftriaxone & fluoroquinolones
Diagnosis:
Stool/blood culture
Occasionally bone marrow aspirate

23
Q

Describe Salmonella typhi source of infection, symptoms & complications, treatment & diagnosis

A

Source of infection:
Faeco-oral transmission & human reservoir w/ high infectivity
Symptoms & complications:
Enteric fever: prolonged fever w/ mesenteric lymph nodes, liver & spleen
Initially diarrhoea then constipation & rash
Can lead to haemorrhage from perforation
Treatment:
Oral/IV fluid & electrolyte replacement
Antibiotics ceftriaxone & fluoroquinolones
Diagnosis:
Stool/blood culture
Occasionally bone marrow aspirate

24
Q

What microorganism causes HA diarrhoea

A

Clostridioides difficile (from intestinal flora or acquired)

25
Q

How is spread of C. Diff limited in hospital

A

5 moments of hygiene w/ soap & water
Standard precautions

26
Q

What is the 2 ways in which C.diff is diagnosed

A

Detection of presence of toxin/gene in stool
Sigmoidoscopy/colonoscopy

27
Q

What is the 2 steps to treat C. Diff

A

Discontinue current antibiotics to restore flora
Start on oral vancomycin that destroys pathogen

28
Q

What is the 3 pathogen that causes diarrhoea in HIV patients

A
  1. Cryptosporidium par I’m
  2. Cystoisospora belli
  3. Microsporidium species
29
Q

What is the clinical presentation of diarrhoea in HIV patients

A

Chronic diarrhoea in patients w/ AIDS

30
Q

What is the treatment of diarrhoea in HIV patients

A

Fluid management & ARV
Cystoiospora: contrimoxazole
Microsporidium: albendazole

31
Q

What is a parasite

A

An organism that lives in/on an organism of another species & benefits by deriving nutrient

32
Q

What 4 protozoal is associated with diarrhoea

A
  1. Entamoeba histolytica
  2. Giardia lamblia
  3. Cryptosporidium
  4. Microsporidium
33
Q

What is the two phases of a protozoal infection

A

Trophozite & cyst phase

34
Q

What is important to indicate for lab when testing for entamoeba histolytica

A

It is part of normal flora & needs to be specifically looked for in higher quantities

35
Q

What is the intestinal & extra-intestinal diseases Entamoeba histolytica cause

A

Intestinal: dysentery, fulminant colitis, toxic megacolon & amoeboma
Extra-intestinal: amoebic liver abscess, lung & brain abscess

36
Q

What is the treatment of Entamoeba histolytica

A

Metronidazole

37
Q

What is the clinical presentation of Giardia lamblia

A

Abdominal cramps, nausea, flatulence & watery diarrhoea

38
Q

What is the treatment of Giardia lamblia

A

Metronidazole

39
Q

What is the 4 determining factors when sending a stool sample

A
  1. Disease factors: severity, dysentery & chronic diarrhoea
  2. Patient factors: sepsis, immunocompromised & hospitalised
  3. Pathogen factors: V. Cholera or EHEC
  4. Public health factors: outbreak & surveillance
40
Q

What is the diagnostic approach w/ infectious diarrhoea

A

MC&S
1. Microscopy: RBW, WBC & parasites
2. Culture: stool & blood (specific media for Salmonella, Shingella & Campylobacter)
3. Susceptibility for antibiotics, toxin detection & antigen/antibodies detection

41
Q

What is the 4 management steps in diarrhoea

A
  1. Rehydration & electrolyte replacement (orally or IV)
  2. Antibiotics for dysentery, invasive (Salmonella) & C.diff
  3. Notifiable disease (Listeria, V.Cholerae, S.Typhi, S.Paratyphi)
  4. Limit spread w/ hygiene

Case 8: GIT diarrhoea (11 decks)

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