Infectious Diarrhea Flashcards
Define Infectious Diarrhea
two classes: inflammatory & non-inflamamtory
Infectious Diarrhea (due to crowding, poor sanitation, contamination)
- having BM > 3/x dayily
- 200g of stool +
- lasting less than 14 days
Subtypes
Inflammatory
- Bloody, mucoid, small volume diarrhea
- tenesmus
- fever
- cramps, N/V
- malasia, HA
- Patho: mucosal invasion due to cytotoxic damage within the colon
Causes
- Shigella
- Salmonella
- Camlyobacter
- C. diff
- E. coli (EHEC)
- Entoamoeba
Non-Inflammatory
- patho: hypersecretions or decreased absorbtion in the SMALL INTESTINE; no cell damage because no cytoxins
- Causes: viral, staph, bacisslu cereus, ETEC, giardia, v. cholerae, c. perf.
Symptoms
- LARGE VOLUME STOOLS of diarrhea without pus or blood
- tenusmus,
- N/V
- NO fever
- cramps
Foods that have risk of contamination and causing infectious diarrhea
- custard pastries
- undercooked or processed meats
- warmed steam table food
- eggs, poultry
- raw seafood
- unpastriurized milk
- fruit jucie
- rice
- bean sprouts
Medications that may predispose your pt. to infectious diarrhea
- laxitives
- magnesium antacids
- antibiotics
- digitalis
- quinidine
- looop diueretics
- antihypertensives
- hearbla teas
who are we wokring up the infectious diarrhea in
what type of diagnostic studies may need oto be done for infectiosu diarrhea
if pt. is sick looking
Indications for Testing
- profuse watery diarreha & dehydration
- blood/mucus in stool
- fever
- > 48 hours of persistent symptoms
- severe GI symptoms
- hig risk pts.
- epedemic determinations
- food handlers
- immunocompromised
- extremes of age
LAbs
- chemistry panle (BMP)
- CBC
- stool sample (gram stain, culutre, c. diff, ova & parasites)
- sigmoidoscopy
- blood or culutres
Management of Infectious Diarrhea
- Hydration!!! oral or Vi
- bowel rest!
- bismuth subsalicylate (peptobismol) for anti-inflammatory properties
- inhibition of motility( maybe not – let it run its course)
- imodium (loperimide)
- diphenoxlyate + atropine (lomotil) - proper hygeine
- sitz bath
- hydrocortisone cream
- wipes and pads - Prevention (avoid contaminated water and foods)
- follow up (avoid dairy for 7-10 days)
- emperic antibiotics if….
- + fecal leucocytes
- bloody diarrhea
- fever
- abd. pain
- dehydration
- > 8 stools in 24 hours
- immunocomp.
- hospitalized
giveL ciprofloxicin, bactrum or doxy
Inflammatory Diarrhea: EHEC
e. coli enterhemorrhagic
Etiology (foods that cause)
symptoms
diagnosis
treatment
inflammatory diarrhea: cytotoxin mediated
risks
- undercooked raw BEEF
- raw fruits, milk, veggies
- person or animal
symptoms
- abrupt bloody diarrhea thats purulent
- cramping
- +/- fever
Diagnosis
- stool culture
Management
- supportive
- abx. to decr. HUS risk (not actually; just what moyer said)
Complication
HUS: more common in kids
- microangiopathic hemolytic anemia
- thrmbocytopenia
- renal failure
TTP
Inflammatory Diarrhea: C. Diff
Inflammatory: cytotoxin producing
Causes/Risk
- recent broad spectrum abx. use (clinda or ampicillin)
- elderly
- immunocomp.
- those with bowl disease
- hospitalized
Symptoms
- fever
- abd. pain
- profuse watery diarrhea
- +/- blood
Diagnosis
- stool culutre for c. diff
- sigmoidoscopy: nodular, inflammatory yellow or white mucosal plaques
Treatment
- d/c the abx.
- oral vancomycin or oral metronidazole
- fecal transplant if severe
Complication
- toxic mega colon
Inflammatory Diarrhea: Shigella
Etiology
Symptoms
Diagnosis
Treatment
Etiology
- invasive bacterial infection
Causes
- fecal-oral transmission
- food/water contaminaied
- daycares
- native amaerican reservations
- ghettors
- villages
- those who lack stomach acid are reservres to spread to family
Symptoms
- abrupt onset of blood and pus in diarrhea
- small amounts
- cramps, tensmus
- high fevers
Diagnosis
- culutrures
Treatment
- mild and self limiting
- in severe/elderly/food workers: florquinolones, azithrymycin or cephalosporin
Complications
- s. dysenteriae can cause HUS
- toxic megacolon
- performation/obstruction
- neurological symptoms
- reactive arthritis
Inflammatory Diarrhea: Camplyobacter Jejuni
Etiology
Symptoms
Diagnosis
Treatment
Etiology
invasive bacterial infection
Causes
- undercooked meat
- unpastuerized milk
- summertime spread
Symptoms
- purulent, blood dirrhea
- abd. cramps
- N/V
- fever
Diagnosis
- stool culutre: seagull wing pattern of gram negative rods
Treatment
- supportive
- in high risk: Florquinolones or macrolide
Complicaions
- extraintestinal infection
- arthritis
- GB syndrome
Inflammatory Diarrhea: Salmonella
Etiology
Symptoms
Diagnosis
Treatment
Etiology
- invasive inflammatory infection
Causes
- food (eggs, poultry)
- turtles
Symptoms
- bloody diarrhea
- cramping
- N/V
- fever
Diagnosis
- case based with culutres
Management
- self resolving
- high risk pt (elderly, sickle cell, prostheic valve) give abx: florquinolones, bactrum, azithromycine, ceftriaxone, cefotaxime
Complications
- sepsis
Inflammatory: Entoamoeba Histolytica
Etiology
Symptoms
Diagnosis
Treatment
Etiology
a protozoa infection which invades mucosa
Causes
- feac-oral rroute
-returning travelers or immagrants
Symptoms
- fulminant dysentry
- fever/chills
- bloody diarrhea
- abd. pain
- can be fatal (look very sick!!)
Diagnosis
- stool sample with antigen test
Treatmen t
- tindazole/mentronidazole
Complications
- colon ulceration
- liver abscess
non-inflammatory: Viral
Etiology
Symptoms
Diagnosis
Treatment
remember non-infalmmatory impacts small intestine, hypersecretion and poor absorbtion
Etiology
- most common cause of diarrhea
- norovirus, rotavirus or adenovirus
Causes
- contaminated food/water
- person-person
Symptoms
- large volume, watery diarrhea
- N/V
- headache
- fever, malaise
- abd. cramping & tenderness
- mylagias
- hyperactive BS
Diagnosis
- pt. presentation
Treatment
- symptomatic watch dehydration
non-Inflammatory: Giardia lamblia
Etiology
Symptoms
Diagnosis
Treatment
Etiology
- leading cause of parastic diarrhea
Causes
- human feces contaiminated water
- rocky mts. and st. pete russia
Symptoms
acute: profuse, watery diarrhea, carmps, flatuence, malaise
chronic: greasey large malorderous stools
Diagnosis
- cysts and trophozoites flagelated on stool sample
Treatment
- mentronnidazole
Complications
- malabsorption and weight loss
non-inflammatory: bacillus cereus
Etiology
Symptoms
Diagnosis
Treatment
Etiology: food like rice, bean sprouts, stews and gravy
Symptoms
- vomiting within diarrhea
or
- diarrhea with cramping for 24-48 hours
Diagnosis
- not needed: but stool test ofr toxin
Treatment
- symptomatic
Complciaions
acute hepatic necrosis (rare)
non-inflammatory: ETEC
Etiology
Symptoms
Diagnosis
Treatment
enterotoxigenic e. coli
Etiology
- noninflammatory diarrhea happening after contaminated food/water
travel’rs diarrhear!!!
Symptoms
- watery diarrhea (can be bloody)
- cramping
- 1-5 days or a month
Management
- supportive
- if need be: florquinolones (if traveled to asia: azithromycin
