infectious DIARRHEA Flashcards
define diarrhea
> 3 liquid or semi solid stools daily for at least 2-3 days
inflammatory vs non-inflammatory diarrhea
- inflammatory diarrhea: bloody or purulent diarrhea associated w/ fever, tenesmus & cramps (dysentery)
- non-inflammatory diarrhea: non-bloody–suggests enterotoxic bacterial, viral or protozoan process
what is travelers diarrhea
watery, crampydiarrhea (sometimes fever too) that occurs w/in 10 days of travel to developing nation
4 differential diagnosis for acute (under 14 days) diarrhea
- bacteria or virus
- medication
- food
- mesenteric ischemia
8 differential diagnosis for chronic diarrhea
- parasites
- IBD or IBS
- celiac
- malabsorption
- pancreatic insufficiency
- hyperthyroidism
- endocrine tumor
fifth leading cause of death in kids under 5
diarrheal disease
when do most diarrhea cases happen in the US
winter d/t viruses
2 HEENT signs of dehydration that i dont often think of
sunken eyes
sunken fontanelle in neonates
1 CBC and 2 BMP findings that are suggestive of dehydration
CBC: increased HCT or leukocytosis
BMP: elevated BUN & CR
BMP: possible non-anion gap metabolic acidosis (high Na or low K)
blood cultures are particular helpful for…
salmonellosis
what is the most common testing for diarrhea? what variation of that testing is helpful for chronic diarrhea?
stool antigen & PCR
stool ova & parasite exam– chronic diarrhea
- typohoidal (sewage contaminated water) or non-typhoidal (chicken,eggs, dairy, birds, reptiles) aerobic gram-neg bacillus
- antiacid use
- purulent, bloody (non-typhoid) diarrhea w/ fever or septicemia
what is this? tx?
salmonella gastroenteritis
PO ciprofloxacin 500mg BID x 7-14 days
- gram-neg enterotoxin producng bacillus
- anal-oral transmission & sewage water
- risk factors– daycare
- purulent, bloody, cramping w/ fever
what is this? what is the tx?
shigella
tx: PO cipro 500mg BID x 3 days or Bactrim
- comma-shaped gram neg rod in pairs; seagull shape
- undercooked poultry or raw milk
- purulent, bloody, cramping w/ fever
- increased risk w/ antiacid use
what is this? what is the tx?
campylobacter
**PO azithromycin ** or Cipro
- gram neg bacillus
- cattle; undercook & contaminated ground beef, cider, milk, lettuce
- kids are at risk for HUS
- purulent, bloody cramping w/ fever
what is it and how is it treated?
EHEC ECOLI
NO abx– supportive care
main cause of travelers diarrhea
- ETEC ecoli
- EAEC ecoli
how is travelers diarrhea tx (first line & alt)? how is it prevented ?
tx: PO ciprofloxacin or PO levofloxacin
prophylaxis: PO Rifaximin
- shellfish & sushi
- watery, very dehydrating
- NO fever
condition & tx
vibrio (cholerae)
tx: single dose oral cipro or doxy.
- refrigerated meats, pasteurized milk
- can mimic appendicitis
- bloody watery diarrhea w/ fever
condition & tx
Yersinia
PO cipro or IV doxy (if severe) or IV gentamicin (if severe
- spore forming
- prior abx use
- profuse watery diarrhea
conditon & tx
PO VANCO or PO Fidaxomicin, FMT or colectomy if toxic megacolon
very contagious
most common viral GI pathogen in winter
cruise ships & shellfish
watery diarrhea
norovirus; self limiting + hydration
- resistant to hand washing and most disinfectants
- almost only kids under 3yo
- watery diarrhea w/ low grade fever
Rotavirus
PO vaccine prophylaxis & supportive care
parasitic infection
- fecal-oral; water & food; liver abscess
- watery or bloody & cramping
- parasite
what is it? tx??
amoebiasis
PO tinidazole or PO metronidazole
- contaminated STREAM water while camping
- beaver fever
- watery diarrhea w/ bloating
Giardiasis
PO tinidazole
- fecal-oral route
- AIDS & other immunocompromised
- watery diarrhea
cryptosporidiosis
PO nitazoxanide
BRAT diet
easily digestible foods
tx for minimal dehydratoin (under 3% loss)
1tbsp salt + 2tbsp sugar in 1L water
oral rehydration solution (120-240 ml)
tx for moderate dehydration (3-9% loss)
50-100 ml per kg over 2-4 hrs
tx for severe dehydration (10+% loss)
requires hospitalization for IV hydration of normal saline 20ml/kg until improved
two meds that must be avoided in dysentry or confirmed bacterial or parasitic diarrhea
PO loperamide (imodium)
PO diphenoxylate (lomotil)
ANTIMOTILITY DRUGS
opiod receptor agonist of ENS
PO loperamide (imodium)
acts on pre-synaptic opioid receptors (mainly mu receptors) of the ENS
PO diphenoxylate
- Inhibits DNA synthesis in obligate anaerobes
- avoid alcohol d/t disulfiram rxn
- metallic taste; peripheral neuropathy w/ prolonged use
metronidazole
targets DNA gyrase to impair DNA replication
QT prolongation, interactions w/ di & trivalent cations and spontaneous tendon rupture
PO cipro
impairs precursors to PCN binding proteins for wall stabilization
suspension > pills
PO vancomycin
when is fecal microbiota transplant (FMT) used?
treatment-refractory C. diff
