Infectious Diarrhea 2 Flashcards

1
Q

Most important tx for acute diarrhea

A
  • Hydration, Hydration, Hydration
  • Oral rehydration should always be first line, if possible

– Intestinal glucose absorption via sodium-glucose cotransport remains intact.

– Intestine able to absorb water if glucose and salt are also present.

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2
Q

What does WHO recommend to rehydrate?

A

Pedialyte

A similar solution can be made by adding one-half teaspoon of salt, one-half teaspoon of baking soda, and four tablespoons of sugar to one liter of water.

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3
Q

Why is gatorade not good for people with infectious diarrhea

A

Gatorade not adequate for severely ill patients, but is likely adequate for otherwise healthy patients. – High carbohydrate load, and this can worsen diarrhea

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4
Q

When would we recommend IV rehydration?

A

• When cannot tolerate oral dt:

– Vomiting – Excessive diarrhea

• Electrolyte imbalance

– Infant period (kidney function continues to mature) – Patients on diuretics, cardiac meds or similar meds

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5
Q
  • Moderate to severe travelers’ diarrhea – > four stools daily, fever, blood, pus, or mucus in the stool.
  • Prompt treatment with_____ or TMP-SMZ – can reduce the duration from 3-5 to 1-2 days
A

fluoroquinolone

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6
Q

Fever, bloody diarrhea and the presence of occult blood or fecal leukocytes in the stool. are indication for Emperic treatement of diarrhea EXCEPT

A

– Except, for suspected EHEC or C. difficile infection – Important to test!

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7
Q

What type of pts can receive empiric antibiotic tx?

A

>8 stools per day, volume depletion, symptoms >one week, hospitalized patients, and immunocompromised hosts

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8
Q

What are empirc antibiotic tx for infectious diarrhea

A

Fluoroquinolone for three to five days

• Azithromycin and erythromycin are alternative agents particularly if fluoroquinolone resistance

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9
Q

Pt has flouroquinolone allergy but your attending says to put in order for antibiotics to tx pt that has had bad infectious diarrhea for over a week. What can you prescribe?

A

• Azithromycin and erythromycin are alternative agents particularly if fluoroquinolone resistance

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10
Q

When is the ONLY time we can give anti-motility agents

A

Only if fever is absent and stools not bloody

give Loperamide or diphenoxylate

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11
Q

Complications of giving anti-molitility to pt with infetious colitis

A

– Bacterial translocation

– C. diff –> Toxic megacolon

  • facilitate the development of the (HUS) in EHEC.
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12
Q

gram positive spore forming anaerobic bacteria.

A

Clostridium Difficile

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13
Q

C. difficile found to be associated with use of antibiotics, especially___

A

Clindamycin

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14
Q

Risk factors for C.diff infection

A

• Recent Antibiotic Use

• Age – Does not cause disease in infants

• Duration of Hospital Stay

  • Chemotherapy
  • Inflammatory Bowel Disease • AIDS
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15
Q

Transmission of C.diff and colonization

A

fecal oral

• Asymptomatic colonization:

– 7-26% of Inpatients

– 2% outpatients (no recent HC exposure)

– Newborns have high carrier rate

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16
Q

How long are you at risk for getting C.Diff once you came into contact with person with it vs using antibiotics

A

2-3 days exposed to infection

risk persists for weeks if used antibiotics

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17
Q

Whats tricky about transmission of C.Diff

A

hand sanitizers wont kill it! need to wash with soap and water

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18
Q

Pathogeneticy of C. Diff

A
  1. Antibiotics destroy bacterial flora
  2. C.Diff grows and secreates toxins
  3. Toxins inflame gut
  4. Increase fluid secreation
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19
Q

• Pathogenic strains of C diff produce two toxins

– Toxin A – Toxin B

  • Genes reside on :
  • Toxins shared:
A

same pathogenic locus

similar structural features

20
Q

Key virulence factors in C.Diff infection

A

– flagellar proteins, surface layer proteins and surface exposed adhesion proteins.

21
Q

Endo A toxin is encoded by _____ that acts as potent enterotoxin

22
Q

Endotoxin B is endoced by Tcd B and is a :

A

cytotoxin in vitro

23
Q

C.Diff

  • Toxin A and B each play a role in the disease course of ____
  • FMLH - C diff NAAT testing only for _____
  • Only about __% of strains are toxin B negative.
A

CDI

toxin B

2%

24
Q

new standard for Toxin A and B in C.Diff

A

PCR testing is becoming the new standard and has lower false negative rate

25
C.Diff: hypervirulent strain: Large outbreaks during the past decade with ______ strains
BI/NAP1/027
26
Features of BI/NAP1/027 strains * ___ x more toxin A * ___ x more toxin B and more resistant to flouroquinoles
16x more toxin A 23x more toxin B
27
What makes the BI/NAP1/027 strain of C.Diff so much more virulent
Binary toxin with tcdC gene mutation: increases toxin production
28
 In 2002, Regional outbreak in Quebec  Spread throughout most of the U.S.  In addition to genes coding for toxins A and B, a gene encoding for the binary toxin  Mortality rates up to 6.9% with Higher rate of toxic megacolon
NAP1/BI/027
29
What is concerning about this xray?
toxic megacolon; huge loops of bowel, is surgicla emergency
30
What is concerning about new C.Diff infections?
 More frequent reports of CDI in low risk populations  Young, healthy population  Women in peri-partum  No exposure to antibiotics (concer is cow carriers)
31
What is happening to the rate of C.Diff discharge diagnosis?
It is increasisng
32
Typical clinical presentation of C.Diff infection
– Bloody watery diarrhea – Fever – Abdominal pain – Leukocytosis – Pseudomembranous colitis
33
Severe concerns with C.Diff infection
toxic megacolon, sepsis / cytokine storm, colonic perforation and death.
34
Prevention of C.Diff spread in hospital
* Wearing Gloves (only A-I recommendation) * Hand hygiene/washing (A-II) – Alcohol based hand gels are in-effective against spore-forming organisms * Isolation gowns * Use antibiotics judiciously
35
Treatement options for C.Diff invection
* Vancomycin and metronidazole mainstay therapies for primary initial CDI * Similar efficacy in primary infection
36
What would you prescribe to inpatient vs outpatient with C.Diff infection?
* Out-patient: Metro * In-patient & toxic: Vanco
37
What would make C.Diff disease SEVERE?
– Age \> 65 years – Cr \> 1.5 times baseline. – WBC \> 15K
38
What are some Severe Disease with Complications of C.Diff
– Hypotension/Shock – Ileus – Megacolon (surgical emergency)
39
\_\_\_\_% of patients will experience recurrence of symptoms after initial infection with C.Diff
10–35
40
Risk factors for recurrance or relapse of C.Diff infection
Risk factors for recurrence: – Continued Antibiotics – Age & co-morbidities – Antacid medication immunosuprrestion/deficiency
41
Treatment for Recurrence of C.Diff
* Repeat metronidazole course * Vancomycin (if not tried) – Longer course with taper (if already tried) * Rifaximin * Probiotics (Saccharomyces Boulardii) * Fidaxomicin * Oral IVIG
42
Describe Fidoxomicin and how it worsk
alternative to vancomycin inhibits RNA polymerase (macrocylic)
43
Fidacomacin works against what bacteria
* Lack activity vs gram negative bacteria, therefore, preserving gastrointestinal flora * Low serum concentration, high fecal concentration
44
How does Fidaxomicin compare to vancomycin?
has decreased recurrance, better cure rate but expensive
45
What is the newest and cheapest cure for C.Diff?
• Repopulate gut flora with donor feces – NGT, pill form, enema or endoscopy
46
How did patients that recieved fecal transplant do?
Symptoms improve in 73-100% (mean 83%) • FT appears to be a safe, cheap, and effective procedure.