Infectious Diarrhea

Question 1

Diarrhea is defined as an alternation in normal bowel movement, increase in water content, frequency of stools and volume, generally with ____ bowel movements / 24hrs

Answer 1

3

Question 2

Infectious diarrhea is diarrhea + >1 of the following: _______, _______, ___________, ___________, fecal urgency, tenesmus

Answer 2

N/V, fever, abdominal cramps, blood in stool

Question 3

The 4 different classifications of diarrhea?
1
2
3
4

Answer 3

1 Acute (1-2 days, may persist up to 14 days)
2 Persistant (14-29 days)
3 Chronic (may last at least 30 days, symptoms less severe or intermittent)
4 Traveler’s diarrhea

Question 4

Signs of dehydration in adults include:
1
2
3

Answer 4

1 less urination
2 darker urine
3 dry skin

fatigue, dizziness, lighteheaded, confusion

Question 5

Signs of dehydration in children include:
1
2
3

Answer 5

1 dry mouth
2 no tears when crying
3 no wet diaper in >3 hr

sunken eye cheeks, soft spot in skull, high fever, irritability

Question 6

C. difficile typically presents without this feature:

Answer 6

Bloody stool

Fever may or may not
N/V may or may not
Abdominal pain present
Fecal WBC present
Fecal lactoferrin present (means inflammation present)

Question 7

Risk factors for infectious diarrhea:
1
2
3

Answer 7

1 Extremes of age
2 Travel
3 Daycare

Consumption of unsafe food, medications (PPI), recent exposure to abx (past 3 months), immunocompromised etc

Question 8

Non-bloody diarrhea

Neonates - often caused by ______
Travelers - often caused by ______

Bloody diarrhea
Travelers - often caused by ______, shigella, salmonella, campylobacter

Answer 8

Rotavirus
ETEC

Invasive STEC

Question 9

Three antibiotics that increase ones C.Diff infections risk
1
2
3

Answer 9

1 Clindamycin
2 FQ
3 Cephalosporins

Question 10

Risk factors for C.Diff ?
1
2
3

Answer 10

> 65
immunocompromised
Abx exposure

chemo, PPI, hospitalization duration

Question 11

Non drug measures:
Mild diarrhea: use _______
Mod-Severe diarrhea: consider ____

Answer 11

ORS

IV hydration

Question 12

True or false: Do not use alcohol based disinfectants since C.diff spores are not killed

Answer 12

True, frequent hand washing to prevent transmission and outbreaks

Question 13

True or false: Travellers diarrhea does not need fecal sample in order to begin treatment

Answer 13

True

Question 14

For treatment of infectious diarrhea, the following are your options:
Adults: _____ or _____
Children ____ or ______

Answer 14

Adults: FQ or macrolide

Children: tmp-smx or macrolide (azithromycin)

Question 15

True or false: antibiotics are not recommended for preventing C.diff

Answer 15

True

Question 16

C.Diff management first involves the following:
1
2
3

Answer 16

1 discontinue other abx if possible
2 discontinue anti-diarrheals
3 discontinue PPI if not indicated (may help reduce recurrence, unlikely to impact acute treatment)

Question 17

Mild non severe C.Diff is defined as:
_________ AND ________

Answer 17

WBC <15,000 AND SCr <1.5 times baseline (<133)

Question 18

Severe C.Diff is defined as:
_______ OR ________

Answer 18

WBC > 15,000 OR SCr >1.5 times baseline (>133)

Question 19

Fulminant C.Diff is defined as:
ileum, megacolon, ________ or ______

Answer 19

hypotension or shock

Question 20

What is the preferred treatment for initial C.Diff episode and NON SEVERE
1
2
3

Answer 20

1. Fidaxomicin 200 mg po bid x 10 days
2. vancomycin 125 mg po qid x 10 days (DOC PREGNANCY)
3. Metronidazole 500 mg po tid x 10 days

Question 21

What is the preferred treatment for initial C.Diff episode and SEVERE
1
2

Answer 21

1. Vanco
2. Fidaxomicin

Question 22

What is the preferred treatment for initial C.Diff episode and FULMINANT
1

Answer 22

1 Vanco 125-500 mg po/ng QID + metro IV q8h

Question 23

For the treatment of C.Diff, FIRST RECURRENCE, the following can be used
1
2
3

Answer 23

1 Vanco (if metro wasn’t used for first episode)
2 Pulse taper vanco
3 Fidaxo

Question 24

For the treatment of C.Diff, SECOND OR MORE RECURRENCE, the following can be used
1
2
3
4

Answer 24

1 Pulse tapered vanco
2 Vanco then rifaximin
3 Fidaxo
4 Fecal microbiota transplant