Infectious colitis Flashcards
What is Campylobacter?
Campylobacter is the commonest bacterial cause of infectious intestinal disease in the UK.
What is the most common species of Campylobacter?
The majority of cases are caused by the Gram-negative bacillus Campylobacter jejuni.
How is Campylobacter spread?
It is spread by the faecal-oral route.
What is the incubation period for Campylobacter?
The incubation period is 1-6 days.
What are the prodromal symptoms of Campylobacter infection?
Prodrome includes headache and malaise.
What are the common symptoms of Campylobacter infection?
Symptoms include often bloody diarrhoea and abdominal pain that may mimic appendicitis.
What is the management for Campylobacter infection?
It is usually self-limiting; treatment is advised if severe or if the patient is immunocompromised.
When are antibiotics recommended for Campylobacter infection?
Antibiotics are recommended if severe symptoms or symptoms have lasted more than one week.
What is the first-line antibiotic for Campylobacter infection?
The first-line antibiotic is clarithromycin.
What is an alternative antibiotic for Campylobacter infection?
Ciprofloxacin is an alternative, but strains with decreased sensitivity are frequently isolated.
What are some complications of Campylobacter jejuni infections?
Complications may include Guillain-Barre syndrome, reactive arthritis, septicaemia, endocarditis, and arthritis.
What is Clostridioides difficile?
Clostridioides difficile is a Gram positive rod often encountered in hospital practice.
What syndrome does Clostridioides difficile cause?
It causes intestinal damage leading to a syndrome called pseudomembranous colitis.
What leads to the development of C. difficile?
C. difficile develops when the normal gut flora are suppressed by broad-spectrum antibiotics.
Which antibiotics are historically associated with causing C. difficile?
Clindamycin is historically associated, but second and third-generation cephalosporins are now the leading cause.
What are other risk factors for C. difficile infection?
Other than antibiotics, proton pump inhibitors are a risk factor.
What is the pathophysiology of C. difficile?
It is an anaerobic gram-positive, spore-forming, toxin-producing bacillus that transmits via the faecal-oral route.
What toxins does C. difficile release?
It releases two exotoxins, toxin A and toxin B, that act on intestinal epithelial and inflammatory cells.
What are the common features of C. difficile infection?
Common features include diarrhoea, abdominal pain, and a raised white blood cell count (WCC).
What severe condition may develop from C. difficile infection?
If severe, toxic megacolon may develop.
What is the Public Health England severity scale used for?
It is used to determine the severity of C. difficile infection for treatment purposes.
What characterizes mild C. difficile infection?
Normal WCC and typically 3-5 loose stools per day.
What characterizes moderate C. difficile infection?
Increased WCC (< 15 x 10^9/L).
What characterizes severe C. difficile infection?
Increased WCC (> 15 x 10^9/L) or evidence of severe colitis.
What characterizes life-threatening C. difficile infection?
Hypotension, partial or complete ileus, or toxic megacolon.
How is C. difficile diagnosed?
Diagnosis is made by detecting C. difficile toxin (CDT) in the stool.
What does C. difficile antigen positivity indicate?
It shows exposure to the bacteria, rather than current infection.
What is the first-line therapy for the first episode of C. difficile infection?
Oral vancomycin for 10 days.
What is the second-line therapy for the first episode of C. difficile infection?
Oral fidaxomicin.
What is the third-line therapy for the first episode of C. difficile infection?
Oral vancomycin +/- IV metronidazole.
What is the recurrence rate of C. difficile infection?
Recurrent infection occurs in around 20% of patients, increasing to 50% after their second episode.
What is the treatment for recurrent C. difficile infection within 12 weeks of symptom resolution?
Oral fidaxomicin.
What is the treatment for recurrent C. difficile infection after 12 weeks of symptom resolution?
Oral vancomycin OR fidaxomicin.
What is the treatment for life-threatening C. difficile infection?
Oral vancomycin AND IV metronidazole with specialist advice for possible surgery.
What is bezlotoxumab?
Bezlotoxumab is a monoclonal antibody that targets C. difficile toxin B.
What is the current stance of NICE on bezlotoxumab?
NICE does not currently support its use to prevent recurrences as it is not cost-effective.
What is a potential therapy for patients with multiple previous episodes of C. difficile?
Faecal microbiota transplant may be considered.
What is essential for preventing the spread of C. difficile infection?
Isolation in a side room until no diarrhoea for at least 48 hours, and staff should wear gloves and aprons.
What is crucial for hygiene in C. difficile infection prevention?
Hand washing is essential; alcohol gel does not kill C. difficile spores.
What is gastroenteritis?
Gastroenteritis is an inflammation of the stomach and intestines, which can occur at home or while traveling abroad.
What defines travellers’ diarrhoea?
Travellers’ diarrhoea is defined as at least 3 loose to watery stools in 24 hours, with or without abdominal cramps, fever, nausea, vomiting, or blood in the stool.
The most common cause is Escherichia coli.
What is acute food poisoning?
Acute food poisoning describes the sudden onset of nausea, vomiting, and diarrhoea after ingesting a toxin.
What are common causes of acute food poisoning?
Common causes include Staphylococcus aureus, Bacillus cereus, and Clostridium perfringens.
What is the typical presentation for Escherichia coli infection?
Common amongst travellers, it presents with watery stools, abdominal cramps, and nausea.
What is the typical presentation for Giardiasis?
Giardiasis typically presents with prolonged, non-bloody diarrhoea.
What is the typical presentation for Cholera?
Cholera presents with profuse, watery diarrhoea and severe dehydration resulting in weight loss.
Not common amongst travellers.
What is the typical presentation for Shigella infection?
Shigella infection presents with bloody diarrhoea, vomiting, and abdominal pain.
What is the typical presentation for Staphylococcus aureus infection?
Staphylococcus aureus infection is characterized by severe vomiting and a short incubation period.
What is the typical presentation for Campylobacter infection?
Campylobacter infection usually starts with a flu-like prodrome, followed by crampy abdominal pains, fever, and diarrhoea, which may be bloody.
What are the complications associated with Campylobacter infection?
Complications can include Guillain-Barre syndrome.
What are the two types of illness caused by Bacillus cereus?
Bacillus cereus can cause vomiting within 6 hours (typically due to rice) and diarrhoeal illness occurring after 6 hours.
What is the typical presentation for Amoebiasis?
Amoebiasis presents with gradual onset bloody diarrhoea, abdominal pain, and tenderness that may last for several weeks.
What are the incubation periods for Staphylococcus aureus and Bacillus cereus?
The incubation period is 1-6 hours for Staphylococcus aureus and Bacillus cereus (vomiting subtype).
The diarrhoeal illness has an incubation period of 6-14 hours.
What are the incubation periods for Salmonella and Escherichia coli?
The incubation period for Salmonella and Escherichia coli is 12-48 hours.
What are the incubation periods for Shigella and Campylobacter?
The incubation period for Shigella and Campylobacter is 48-72 hours.
What are the incubation periods for Giardiasis and Amoebiasis?
The incubation period for Giardiasis and Amoebiasis is greater than 7 days.
What type of bacteria is the Salmonella group?
The Salmonella group contains aerobic, Gram-negative rods.
Are Salmonella normally present as commensals in the gut?
No, they are not normally present as commensals in the gut.
What causes typhoid and paratyphoid fevers?
Typhoid is caused by Salmonella typhi and paratyphoid by Salmonella paratyphi (types A, B & C).
What are the systemic symptoms of enteric fevers?
Systemic symptoms include headache, fever, and arthralgia.
Which serotypes are common causes of bacterial gastroenteritis?
Salmonella enteritidis and Salmonella typhimurium are common causes.
What is a common source of non-typhoidal Salmonella infections?
The source is often poultry, such as chicken or eggs.
What are the features of non-typhoidal Salmonella infection?
Features include diarrhoea, nausea and vomiting, abdominal cramps, fever, and lethargy.
What does Shigella cause?
Shigella causes diarrhoea (which may be bloody) and abdominal pain.
How does the severity of Shigella infection vary?
Severity depends on the type: S. sonnei (e.g. from the UK) may be mild, while S. flexneri or S. dysenteriae from abroad may cause severe disease.
Is Shigella infection usually self-limiting?
Yes, Shigella infection is usually self-limiting and does not require antibiotic treatment.
When are antibiotics indicated for Shigella infection?
Antibiotics (e.g. ciprofloxacin) are indicated for people with severe disease, who are immunocompromised, or with bloody diarrhoea.
Clostridioides difficile Public Health England severity scale
gastroenteritis infections & presentations
gastroenteritis: infections & presentations
