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MICRO > Infections of GI > Flashcards

Infections of GI Flashcards

1
Q

what is gastroenteritis?

A

inflammatory process of the stomach or intestinal mucosal surface, associated with ingestion of contaminated foods/water/poor sanitation

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2
Q

what is infectious gastroenteritis?

A

pathogen enters GI tract and multiplies, delayed appearance in symptoms (1-3 days), pathogens increase which increases damage, associated w fever

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3
Q

what is intoxication gastroenteritis?

A

ingestion of preformed toxin (exotoxin), sudden appearance of symptoms (2-10 hrs after consumption), fever not common

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4
Q

characteristics of stool that infection/intoxication gastroenteritis produces?

A
  • increases frequency (>3 stools/day)
  • increased volume (>200ml excreted/day)
  • soft, not formed
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4
Q

characteristics of stool that infection/intoxication gastroenteritis produces?

A
  • increases frequency (>3 stools/day)
  • increased volume (>200ml excreted/day)
  • soft, not formed
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5
Q

symptoms of gastroenteritis

A

abdominal pain/cramping, diarrhea, nausea/vomtiing, dehydration, wt loss, fatigue and fever

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6
Q

what are the two types of acute diarrhea?

A

inflammatory and non inflammatory

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7
Q

what is inflammatory acute diarrhea?

A

typically caused by bacteria (shigella app, salmonella enteric, campylobacter jejuni), characterized by an infection causing frequent, small volume and loose stools

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8
Q

what does the stool typically look like in inflammatory acute diarrhea?

A

blood (gross or occult) often present, presence of fecal leukocytes and mucous
- dysentery; severe diarrhea containing visible blood, mucous and or pus

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9
Q

what is invasive diarrhea?

A

sublet of inflammatory diarrhea, inflammatory diarrhea AND invasion of intestinal mucosa (increased risk of bacteremia), ex. salmonella spp, verocytotoxin-producting E coli

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10
Q

what symptoms must be present for a physician consultation?

A
  • fever (>38.5 C)
  • significant abdominal pain
  • dehydration
  • visible blood and mucis/pus in the stool
    as well as further lab testing and antimicrobial therapy
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10
Q

what should be gathered in a pt Hx?

A

(disease severity risk factors)
- symptom duration - fever, abdominal pain, nausea/vomiting, dehydration an fatigue
- description of diarrhea
- investigate for common source of outbreak
- travel Hx or recent antibiotic use

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11
Q

what does a short incubation period suggest?

A

ingestion of pre formed toxin

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12
Q

what should be considered when vomiting is a dominant symptom?

A

viral infection or food poisoning

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13
Q

risk factors:

A
  • age over 70
  • neonates
  • recent travel or camping
  • recent antibiotic use
  • immunosuppression (prednisone, chemotherapy, HIV/AIDS
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14
Q

what 4 factors are used to establish dehydration?

A
  • ortho hypotension
  • tachycardia
  • decreased skin turgor
  • dry mucous membranes
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15
Q

when should cultures be performed?

A

for pt with severe or persistent disease (>1 week)

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16
Q

when is a positive culture rare? (2-5%)

A

pt without fever and absence of occult blood or fecal leukocytes in the specimen

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17
Q

when is a culture not recommended?

A

if pt has been in hospital for 72 hours an has new onset diarrheal symptoms (can indicate c diff)

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18
Q

when are studies for ova and parasites indicated?

A
  • persistent diarrhea
  • international or wilderness travel, daycare centres
  • immunosuppression (eg. HIV/AIDS)
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19
Q

when does lab sensitivity increase to 98%

A

if 3 ova and parasite examinations are preformed on 3 separate days

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20
Q

molecular assays are becoming more available for the identification of:

A

salmonella app, shigella spp, campylobacter spp, and verocytotoxigenic E.coli

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21
Q

acute diarrhea may also be associated with what conditions?

A

IBS, bowel obstruction and GI hemorrhage

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22
Q

what medications can cause diarrhea?

A

metformin, colchicine, diuretics, ACE inhibitors, PPIs magnesium containing antacids, antibiotics

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23
Q

what is the goal of management for acute diarrhea?

A

to pass relatively dilute urine every 2-4 hours

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24
Q

how can you treat acute diarrhea?

A
  • oral fluids (eg. water, pedialyte, hydralyte) usually sufficient
  • IV fluids recommended in cases of severe dehydration or persistent emesis
  • patients should eat until stool is formed
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25
Q

agents to control diarrhea:

A
  • bulking agents, bismuth compounds, anti motility drugs (loperamide)
  • should only be used in cases of non inflammatory diarrhea
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26
Q

when is empiric antimicrobial therapy recommended?

A

in severe cases of infectious bacterial gastroenteritis

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27
Q

what must be confirmed right before antimicrobial therapy is started?

A

positive stool culture or parasite examination
- then therapy should be started to treat specific pathogen

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28
Q

infection control

A
  • routine practices and contact precautions
  • case notification and outbreak notification
  • source control to prevent new cases
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28
Q

is campylobacter jejuni gram neg or pos and what’s the shape?

A

gram negative, helical shaped bacteria

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29
Q

what are the symptoms of campylobacter jejuni?

A

fever, abdominal pain/cramping, blood streaked, inflammatory diarrhea (>10 BM/day)

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30
Q

when do symptoms typically resolve in campylobacter jejuni?

A

within 1 week

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31
Q

what is the leading cause of food borne illness in North America?

A

campylobacter jejuni

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32
Q

80% of retail chicken is contaminated with what?

A

campylobacter jejuni

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33
Q

approx 60% of cattle excrete what in faces and milk?

A

campylobacter jejuni

33
Q

how is campylobacter jejuni transmitted?

A

ingestion of contaminated food and water (fecal oral route)

34
Q

what is the infectious dose of campylobacter jejuni?

A

100-10,000 organisms

35
Q

what is the infection control (community) for campylobacter jejuni?

A
  • good hygiene after handling raw poultry, dog and cat feces
    -proper refrigeration
  • pasteurization of milk and chlorination of water supply
36
Q

is salmonella enterica gram neg or pos and what is the shape?

A

gram neg, bacillus shaped bacteria

37
Q

salmonella enterica is associated with what two conditions?

A
  • typhoid (enteric) fever (typhi & paratyphi)
  • salmonellosis
38
Q

what is the treatment for salmonella enterica?

A

requires antibiotic therapy due to increased risk of life threatening complications

39
Q

what are the symptoms of salmonellosis?

A

abdominal pain, cramps, inflammatory diarrhea (neg for blood), fever, nausea, loss of appetite, headache, myalgia, malaise

40
Q

when do symptoms typically resolve with salmonellosis?

A

within 1 -2 weeks

41
Q

what is the Tx for salmonellosis?

A

require supportive therapy only, antibiotics reserved for severe cases

42
Q

how is salmonellosis transmitted?

A

ingestion of contaminated food an water (raw/undercooked meats, eggs, raw fruits an veggies, seafood)
- fecal oral route (pets an people, eg. turtles an iguanas)

43
Q

what is the infection control (community) for salmonellosis?

A
  • proper refrigeration
  • avoid cross contamination of uncooked foods with raw foods that may contain salmonella enterica
  • good hand hygiene after handling animals
44
Q

is enterotoxigenic E.coli gram neg or pos and what’s the shape?

A

gram neg, bacillus shaped bacteria

45
Q

what is enterotoxigenic E.coli commonly referred to as?

A

“travellers diarrhea”

46
Q

what are the symptoms of enterotoxigenic E.coli?

A

water non inflammatory diarrhea, 4-5 loose/watery stools per day, abdominal cramps, bloating, nausea an vomiting, fever

47
Q

when do symptoms typically resolve in enterotoxigenic E.coli?

A

1-3 days

48
Q

how is enterotoxigenic E.coli transmitted?

A
  • ingestion of contaminated food an water
  • person to person (fecal oral)
49
Q

what is the infectious dose in enterotoxigenic E.coli?

A

100 organisms

50
Q

in a severe case of enterotoxigenic E.coli, what symptoms will you experience?

A

dehydration, bloody stools, persistent vomiting, an high fever (>38.9 c)
- antibiotic Tx reserved for severe cases

51
Q

what is the infection control (community) for enterotoxigenic E.coli?

A

“boil it, cook it, peel it or forget it” and avoid consuming non-sterile sources of water

52
Q

what is the Dukoral (oral vaccine)?

A
  • adults an children minimum 2 yrs old
  • contains killed V. cholerae an attenuated V cholerae enterotoxin
53
Q

what is the most common strain in Canada?

A

enterhemorrhagic E.coli (EHEC)

54
Q

what are the symptoms of verocytotoxigenic E. coli (VTEC)?

A

inflammatory diarrhea (10 or more BM/day), abdominal cramping, pain, tenderness, low grade fever
- hemorrhagic colitis in 6% of patients, usually 24 hours after symptom onset

55
Q

what are the symptoms of verocytotoxigenic E. coli (VTEC)?

A

inflammatory diarrhea (10 or more BM/day), abdominal cramping, pain, tenderness, low grade fever
- hemorrhagic colitis in 6% of patients, usually 24 hours after symptom onset

56
Q

when do symptoms typically resolve in verocytotoxigenic E. coli (VTEC)?

A

within 1 week (in healthy adults)

57
Q

how is verocytotoxigenic E. coli (VTEC) transmitted?

A
  • contaminated milk, fruit juice, ground beef, an produce (spinach, sprouts)
  • person to person (fecal-oral)
58
Q

what is the infection control (community) for verocytotoxigenic E. coli (VTEC)?

A

avoid consuming non sterile sources of water, watch for contaminated foods and proper cooking of contaminated meats

59
Q

what symptoms occur in hemolytic ureic syndrome (HUS)?

A

fever, abdominal pain, pale skin tone, fatigue an irritability, small bruises or bleeding from nose/mouth, decreased urination, swelling of face/hands/feet

60
Q

what is the complication (HUS) associated with?

A

branch of verocytotoxigenic E. coli (VTEC), associated with age extremes, occurs 3-7 days after onset

61
Q

what does verocytotoxin do in the bloodstream?

A

invades blood stream an destroys RBCs, damaged RBCs clog the microvasculature of the kidney, causing kidney failure

62
Q

what is HUS aggravated by?

A

anti motility drugs an antibiotics

63
Q

what is the Tx of verocytotoxigenic E. coli (VTEC)?

A

RBC an platelet transfusions, plasma exchange, kidney dialysis

64
Q

what is the leading cause of acute kidney failure in children?

A

hemolytic uremic syndrome (HUS)

64
Q

is shigella spp. gram neg or pos and what is the shape?

A

gram neg, rod shaped bacteria

65
Q

what is the most common species in North America?

A

S. Sonnei (branch of shigella spp.)

66
Q

what population are most susceptible to S. Sonnei (shigella spp.)?

A

children between 2 an 4 years

67
Q

how is S. Sonnei (shigella spp.) transmitted?

A

contaminated food an water, person to person (fecal-oral)
- most commonly associated with poor hygienic conditions an overcrowding

68
Q

what is the infectious dose for Sonnei (shigella spp.)?

A

10-100 organisms

69
Q

what symptoms occur with shigellosis ?

A

inflammatory diarrhea (bloody an may contain mucous), abdominal cramps, rectal pain, fever an nausea

70
Q

when do symptoms typically resolve for shigellosis?

A

2-3 days (carrier status, 4 weeks)

71
Q

what is shigella dysenteriae?

A

severe purulent (mucous an pus) bloody stools, antibiotic therapy required, produce a shiga toxin similar verocytotoxin (VTEC)

72
Q

is C diff gram pos or neg and what shape?

A

gram pos, endospore forming bacteria

73
Q

how does inflammation occur in the colon in C. diff?

A

produce exotoxins that cause inflammation of the colon accompanied by increased fluid secretion an permeability of intestinal mucosa
- enterotoxin (toxin A): diarrhea an inflammation
- cytotoxin (toxin B): induces cell damage and facilitates lesion formation

73
Q

when should C. diff be suspected?

A

any client who has diarrhea in association with broad spectrum antibiotic exposure (<2 months of symptoms)
- fluoroquinolones, clindamycin, penicilin

74
Q

what are symptoms of c diff?

A

water, foul smelling diarrhea, mild abdominal cramping an tenderness

75
Q

what is a complication of c diff?

A
  • pseudomembranous colitis
    (>10 bloody stools/day, intestinal lesions; on colonoscopy, the colonic mucosa contains small, raised, yellowish plaques)
  • bowel perf due to damage in intestine
  • toxic megacolon, gross distention of colon
76
Q

what is the Tx for c diff?

A

discontinuation of antimicrobial agent an supportive therapy
- if symptoms do not resolve give vancomycin
- relapse in 10-20% of patients (fecal transplants)

77
Q

is viral or bacterial gastroenteritis more severe?

A

bacterial

78
Q

what are symptoms of viral gastroenteritis?

A

secretory diarrhea, abdominal cramping, nausea/vomiting, fever, chills, clammy skin, wt loss an lack of appetite

79
Q

when do symptoms commonly appear in viral gastroenteritis?

A

within 24 hours of infection an resolve within 12 to 60 hours after symptom onset

80
Q

viruses infect epithelial cells of the intestinal tract where they undergo which process?

A

lytic replication

81
Q

in viral gastroenteritis, what happens once epithelial cells are destroyed?

A

replacement cells grow an function is restored

82
Q

how is viral gastroenteritis transmitted?

A

contaminated food and water, person to person, aerosols from vomit

MICRO (4 decks)

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