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GI II Exam II AP > Infectious Diarrhea > Flashcards

Infectious Diarrhea Flashcards

1
Q

common in areas with poor sanitation

comma-shaped, gram negative

Ganges Valley of India and Bangladesh

fecal oral, water transmission, shellfish!

noninvasive! remains

has a toxin and flagella

“rice water” stools, severe watery diarrhea

A

Cholera

-causes diarrhea b/c the chloride, sodium, bicarb in the lumen create osmotic force that draws water into the lumen

you can get this again- there’s no immunity!!!

death can occur b/c of dehydration ! losing massive amounts of fluid

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2
Q

what are the complications of cholera

A 
dehydration
hypotension
muscular cramping 
anuria 
shock 
LOC 
death (mostly within the first 24 hrs after presentation)
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3
Q

Gram negative
comma shaped

most common enteric pathogen in developed countries

causes travelers diarrhea, either bloody*** or non
flu-like prodrome with fever

ingestion of improperly cooked chicken, unpasturized milk or contaminated water

produces a toxin

can result in reactive arthritis (HLA-B27), erythema nodosum, Guillain-Barre

diagnose by stool culture

A

Campylobacter

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4
Q

what is the potential pathogenesis of Guillan Barre syndrome associated with campylobacter

A

Molecular mimicry has been implicated in the pathogenesis of Guillain-Barré syndrome, as serum antibodies to C. jejuni lipopolysaccharide cross-react with peripheral and central nervous system gangliosides.

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5
Q

treatment for campylobacter

A

antibiotics are not required

liquids? hydration?

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6
Q

gram negative , unencapsulated, non motile, facultative anaerobes

very bloody diarrhea *** with a high fever

fecal-oral route or via contaminated water and food

taken up by M cells in the intestine and eventually invade basolateral membranes

most prominent in the left colon and ileum

1 week of diarrhea that progresses to bloody diarrhea in 1/2 pt’s

can also mimic new onset ulcerative colitis

A

Shigellosis

self-limited disease

A 32 y/o old owner of a day care center presents with a two day history of bloody diarrhea and a fever of 102. She notes that several of the children in her center have had similar symptoms. You suspect which of the following organisms:

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7
Q

what are the complications of shigella infection

A

sterile reactive arthritis

urethritis

conjunctivitis

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8
Q

treatment of shigella infection

what is contraindicated in the treatment of shigella

A

antibiotics shorten the course and reduce duration of shedding in stool - fluoroquinolone

anti-diarrheal’s are contraindicated b/c they prolong symptoms and delay clearance

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9
Q

gram negative bacilli

infection most common in young children and older adults

ingestion of contaminated food, raw or undercooked meat, poultry, eggs, milk

stool culture for diagnosis

watery or bloody diarrhea

colon and small intestine

A

Salmonella

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10
Q

treatment of salmonella

A

antibiotic therapy not recommended b/c it can prolong the carrier state

self-limited disease

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11
Q

children and adolescents are affected more often

Travel to India, Mexico, Philippines, Pakistant, El Salvador, Haiti

persons to person or via food or water

enlarged peyer patches in terminal ileum

enlarged spleen
nodules in the liver

anorexia, abd pain, bloating, nausea, vomiting, bloody diarrhea

inconsistent heart rate with fever (relative bradycardia) - low heart rate compared to high fever

rose spots - chest and abdomen

A

Typhoid fever caused by salmonella enterica (typhi and paratyphi)

NOTE- S. typhi can disseminate via lymphatic and blood vessels

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12
Q

how do you treat typhoid fever

A

generally you don’t treat with antibiotics b/c it can prolong>

In patients who do not receive antibiotics, the initial febrile phase continues for up to 2 weeks; patients have sustained high fevers and abdominal tenderness that may mimic appendicitis.

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13
Q

what are the complications of typhoid fever and which patients are highly susceptible to salmonella osteomyelitis?

A

Systemic dissemination may cause extraintestinal complications including encephalopathy, meningitis, seizures, endocarditis, myocarditis, pneumonia, and cholecystitis.

Patients with sickle cell disease are particularly susceptible to Salmonella osteomyelitis.

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14
Q

abdominal pain (RLQ), fever, diarrhea

ingestion of pork, raw milk, contaminated water

Iron enhances virulence

preferentially involve the ileum, appendix and right colon

regional lymph node and peyer patch hyperplasia

bowel wall thickening

looks similar to crohn’s

extraintestinal manifestations include–> pharyngitis, arthralgia, erythema nodosum

A

Yersinia Enterocolitica - more common
Yersinia Pseudotuberculosis

can mimic acute appendicitis **

can be associated with sore throat and reiter’s syndrome (uveitis, arthritis,

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15
Q

travelers diarrhea

spread via contaminated food or water (fecal oral route)

children induce chloride and water secretion

secretory, noninflammatory diarrhea, dehydration, shock

A

enterotoxigenic e coli (ETEC)

can cause dehdyration and electrolyte imbalance

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16
Q

Diarrheal outbreaks, particularly in children < 2 years of age

cause effacement of microvilli

causes watery diarrhea

dehydration and electrolyte imbalance

A

enteropathogenic e coli (EPEC)

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17
Q

gram negative rods

bloody diarrhea

consumption of inadequately cooked ground beef, contaminated milk

shiga-like toxin

antibiotics are NOt recommended –> b/c of enhanced risk of hemolytic uremic syndrome (especially in children) b/c of release of shiga-like toxin

A

enterohemorrhagic e. coli

think boy scouts who at the hamburgers

18
Q

transmitted via food, water or by persons-to-person contact

affect primarily young children

occurs in the colon

bloody diarrhea

more common in underdeveloped countries

A

enteroinvasive e coli

19
Q

antibiotic associated - clindamycin

at risk are the advanced age, hospitalization, antibiotic treatment

fever, leukocytosis, abdominal pain, cramps, watery diarrhea, dehydration

hypoalbuminemia

diagnosis with toxins in stool

A

pseudomembranous colitis

generally caused by C. difficile

20
Q

how do you treat c diff

how do you prevent the spread of this?

A

metronidazole first (b/c its cheaper) - make sure they don’t drink when they take this!

oral vancomycin second
Fidaxomicin

prevent the spread of this illness by…. they are able to survive by spore formation and its the lathering up/saponification that kills the spore

21
Q

malabsorption, lymphadenopathy, arthritis of undetermined origin

foamy macrophages in the small intestinal lamina propria - PAS positive

most common in caucasian men, farmers

diarrhea, weight loss, arthralgia

A

Gram positive Tropheryma whippelii responsible for Whipple disease

Clinical symptoms occur because organism-laden macrophages accu­mulate within the small intestinal lamina propria and mesenteric lymph nodes, causing lymphatic obstruction. Thus, the malabsorptive diarrhea of Whipple disease is due to impaired lymphatic transport.

22
Q

why would someone have bleeding from foley catheters and injection sites as well as some minor bloody diarrhea if they have c. diff

A

vitamin K deficiency from malabsorption

most humans get vitamin K from gut bacteria

bacteria in the gut provide vitamin K supply- wipe out the bacteria (b/c of multiple antibiotics) you get prone to bleeding (clotting factors that lack vitamin K)

23
Q

contaminated food, water and person to person transmission

Bloody diarrhea

cruise ships and dorms

kills many children per year

adults and kids are affected!

High fever, abdominal pain, and sore throats can be associated with this

A

norovirus

24
Q

how do you make the diagnosis of c. diff

A

toxin in stool

PCR?

25
Q

children b/w ages 6-24 are at most risk

outbreaks in hospitals and day care centers

osmotic diarrhea b/c it causes loss of absorptive function

A

rotavirus

26
Q

nematode

human fecal oral contamination

enter intestine- go to lungs- larvae are coughed up and swallowed - larvae mature into adults in the intestine

eggs in stool sample

A

Ascaris lumbricoides

27
Q

larvae living in ground soil penetrate and unbroken skin

migrate through lungs –> reside in intestine while maturing into adult worms

eggs hatch within the intestine and release larvae that penetrate mucosa causing autoinfection

can persist for life

A

strongyloides

28
Q

spread by fecally contaminated water or food

rural streams

flagellated protozoan that cause decreased expression of brush border enzymes

diarrhea

cysts in stool

A

giardia lamblia

29
Q

parasite

acute, self-limited disease in immunologically normal hosts or immunosuppressed

contaminated drinking water

takes up residence in the enterocytes

leads to sodium malabsorption, chloride secretion, increased tight junction permeability

nonbloody diarrhea

presents often in kids b/c they don’t have strong immune system

A

cryptosporidium

30
Q

how do you diagnose cryptosporidium parvum

A

mildly acid fast positive

31
Q

antibiotic induced diarrhea

A

this occurs very quickly whereas C diff might take longer to occur

Amoxicillin/Clavulanic acid = Augmentin - notorius for causing diarrhea

The clavulanic acid is what causes it typically

Its a beta-lactamase inhibitor so it makes the amoxicillin last longer/more effective

32
Q

vibrio parahaemolyticus

A

seafood and shellfish

12-72 hour incubation

non bloody diarrhea

33
Q

mayo and cream pies

A

staphylococcus aureus

34
Q

cheese and milk

raw meat or seafood too

differential with monocytes

presents in newborns, frail elderly and immunocompromised

A

listeria monocytogenes

this can cause meningitis in kitties- it tends to be a monocytosis in the white cell count and this is how the organism got its name

35
Q

protozoan

recent travel history to India

causes abscesses in liver and brain- liver is the most common site for extraintestinal disease

MC site for extraintestinal disease but lung and brain spread are common

bloody diarrhea

weight loss

A

Entamoeba histolytica

36
Q

ingestion of fried rice and white rice

incubation 12-48 hrs

watery diarrhea

intestinal cramping

A

Bacillus cereus

37
Q

watery diarrhea, blood tinged

basophilic intranuclear inclusion bodies

A

CMV

CD4 count <50

38
Q

phenolphathalein

A

this is a laxative

39
Q

what other infectious diseases do people who are immunocompromised get that causes diarrhea

A

cryptosporidium
MAC
cytomegalovirus
isospora and cyclospora

anything that can normally cause diarrhea too

40
Q

augmentin effects on GI system?

A

causes severe diarrhea

41
Q

how do you treat entamoeba histolytica

A

metronizadole

GI II Exam II AP (2 decks)

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