Infectious Diarrhea 2 Flashcards
Most important tx for acute diarrhea
- 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.
What does WHO recommend to rehydrate?
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.
Why is gatorade not good for people with infectious diarrhea
Gatorade not adequate for severely ill patients, but is likely adequate for otherwise healthy patients. – High carbohydrate load, and this can worsen diarrhea
When would we recommend IV rehydration?
• 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
- 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
fluoroquinolone
Fever, bloody diarrhea and the presence of occult blood or fecal leukocytes in the stool. are indication for Emperic treatement of diarrhea EXCEPT
– Except, for suspected EHEC or C. difficile infection – Important to test!
What type of pts can receive empiric antibiotic tx?
>8 stools per day, volume depletion, symptoms >one week, hospitalized patients, and immunocompromised hosts
What are empirc antibiotic tx for infectious diarrhea
Fluoroquinolone for three to five days
• Azithromycin and erythromycin are alternative agents particularly if fluoroquinolone resistance
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?
• Azithromycin and erythromycin are alternative agents particularly if fluoroquinolone resistance
When is the ONLY time we can give anti-motility agents
Only if fever is absent and stools not bloody
give Loperamide or diphenoxylate
Complications of giving anti-molitility to pt with infetious colitis
– Bacterial translocation
– C. diff –> Toxic megacolon
- facilitate the development of the (HUS) in EHEC.
gram positive spore forming anaerobic bacteria.
Clostridium Difficile
C. difficile found to be associated with use of antibiotics, especially___
Clindamycin
Risk factors for C.diff infection
• Recent Antibiotic Use
• Age – Does not cause disease in infants
• Duration of Hospital Stay
- Chemotherapy
- Inflammatory Bowel Disease • AIDS
Transmission of C.diff and colonization
fecal oral
• Asymptomatic colonization:
– 7-26% of Inpatients
– 2% outpatients (no recent HC exposure)
– Newborns have high carrier rate
How long are you at risk for getting C.Diff once you came into contact with person with it vs using antibiotics
2-3 days exposed to infection
risk persists for weeks if used antibiotics
Whats tricky about transmission of C.Diff
hand sanitizers wont kill it! need to wash with soap and water
Pathogeneticy of C. Diff
- Antibiotics destroy bacterial flora
- C.Diff grows and secreates toxins
- Toxins inflame gut
- Increase fluid secreation
• Pathogenic strains of C diff produce two toxins
– Toxin A – Toxin B
- Genes reside on :
- Toxins shared:
same pathogenic locus
similar structural features
Key virulence factors in C.Diff infection
– flagellar proteins, surface layer proteins and surface exposed adhesion proteins.
Endo A toxin is encoded by _____ that acts as potent enterotoxin
TcdA
Endotoxin B is endoced by Tcd B and is a :
cytotoxin in vitro
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.
CDI
toxin B
2%
new standard for Toxin A and B in C.Diff
PCR testing is becoming the new standard and has lower false negative rate
