Infectious Diarrhea

Question 1

What are risk factors for infectious diarrhea

Answer 1

Child care facilities, foodborne or waterborne, international travel, antimicrobial agents

Question 2

What are the three most common organisms that cause infectious disease

Answer 2

Shigella, camplyobacter, and non-typhoidal salmonella

Question 3

What are the two types of medications should be considered when someone has diarrhea

Answer 3

anti-motility agents and antibiotics

Question 4

T/F: Inflammaotry diarrhea is a self limiting illness and should be considered for antibiotics but instead anti-motility

Answer 4

False: Non-inflammatory diarrhea is self-limiting and antibiotics are not needed but anti-motility drugs usually are. Inflammatory diarrhea should have antibiotics considered specific to pathogens and hosts

Question 5

What are characteristics of inflammatory diarrhea

Answer 5

Appearing ill, febrile, stool WBCS, bloody diarrhea

Question 6

T/F: In patients with fever or bloody diarrhea anti-motility drugs may worsen illness by impairing elimination of pathogens and their toxins

Answer 6

True

Question 7

What is the recommended anti-motility drugs

Answer 7

Loperamide

Question 8

If the infectious diarrhea is acute (less than 14 days) what are the two ways routes for exposure

Answer 8

Community acquired or travel, hospital exposure

Question 9

What are the organisms associated with community-acquired or travel infectious diarrhea

Answer 9

Salmonella, shigella, camplyobacter, E. coli (shiga-toxin)

Question 10

What is the organism associated with hospital acquired with infectious diarrhea

Answer 10

C. difficile

Question 11

If the infectious diarrhea is chronic (greater than 14 days) what is the usual route of exposure, what organism is associated

Answer 11

Recreational water exposure, giardia

Question 12

When are antibiotics generally recommended

Answer 12

Severely ill patients, Immunocompromised patients (organ transplantation, AIDS), Treatment of extra-intestinal infections, specific pathogens

Question 13

What are adverse consequences of antiboitcs

Answer 13

Prolonged fecal excretion of pathogens, emergence of resistant bacteria, side effects

Question 14

What empiric treatment choices for antibiotics

Answer 14

Floriquinolones, azithromycin, ceftriaxone, cefotaxime

Question 15

What is the salmonella species that is most likely to cause a systemic infection the will require antibiotics, what is the name of the disease associated with this type of salmonella

Answer 15

S. Typhi, Typhoid fever

Question 16

What are the resistance patterns for Salmonella Typhi

Answer 16

Fully susceptible to all relevant antibiotics, multi drug resistance but fully fluroquinolone susceptible, fluroquinolone resistant

Question 17

What are the first line antibiotics for S. typhi that is fully susceptible and how long they used, what are the alternatives and how long are they used

Answer 17

Fluoroquinolones for 5-7 days/ Ampicillin OR Bactrim OR Chloramphenicol for 14-21 days

Question 18

What are the first line antibiotics for multi drug resistance but fully fluroquinoline susceptible strands of S. typhi

Answer 18

Fluroquinolones for 5-7 days

Question 19

Resistance to what prototype structure may predict fluroquinolone resistance

Answer 19

Nalidixic-acid

Question 20

T/F: The lower the MIC the more the less likely that resistance is present

Answer 20

True

Question 21

What are the treatment options for low-level fluroquinolone resistance

Answer 21

Maximum dose of a FQ OR Azithromycin OR Ceftriaxone for 7 days

Question 22

What are the treatment options for high-level fluroquinolone resistance

Answer 22

Ceftriaxone for 10-14 days OR Azithromycin for 7 days

Question 23

What is the diseae that can be caused by chronic carrying of S. typhi in the gallbladder, how can this be treated

Answer 23

Typhoid fever, 1-3 months of antibiotics

Question 24

What are the the spectrum of illness in non tyhphi salmonella

Answer 24

Gastroenteritis, bacteremia

Question 25

If a patient presents with gastroenteritis are antibiotics indicated, why

Answer 25

generally not indicated in healthy adults, antibiotics may prolong fecal excretion of salmonella

Question 26

T/F: Bacteremia is a systemic infection that happens in less than 5% of patients

Answer 26

True

Question 27

What instances when pre-emptive antibiotics before extra intestinal infections occur

Answer 27

age less 1 year or greater than 50, immunosuppressed, severe symptoms such as fever and bloody diarrhea,

Question 28

How long should antibiotics be taken for bactermia and pre-emptive antibiotics what are those antibiotics as well

Answer 28

Ceftriaxone (empiric choice) 3-7 days, floriquinolone, ampicillin/amoxicillin, bactrim

Question 29

If a patient has shigella and a mild to moderate illness what shoud the antibiotic therapy be

Answer 29

1 to 2 doses of a fluroquinolone

Question 30

If a patient has shigella and a severe illness caused by S. dysenteria what should the antibiotic therapy be, what if there is fluroquinolone-resistanace

Answer 30

3 to 5 days of a fluroquinolone, ceftriaxone or azithromycin

Question 31

T/F: Camplyobacter usually requires antiboitic treatment

Answer 31

False: Camplyobacter is usually a self-limiting illness with a 1 week duration

Question 32

If someone has camplyobacter when is antibiotics recommended

Answer 32

High fever, bloody diarrhea, pregnancy, the illness last longer than one week

Question 33

What antiboitic regimen should be used to treat camplyobacter

Answer 33

Azithromycin or erythormycin

Question 34

What type of presentations come from Shiga-toxin diarrhea

Answer 34

Bloody diarrhea without fever

Question 35

What is the Shiga-toxin, sympotoms

Answer 35

Key virulence factor in the development of hemolytic uremic syndrome/ renal insufficiency, anemia, thrombocytopenia

Question 36

T/f: Shiga-toxin E coli. should not recieve antibiotics

Answer 36

True

Question 37

What practices will reduce the incidince of C. difficile diarrhea

Answer 37

Proper handwashing, limiting use of clindamycin, limiting use of cephalosporins, limiting use of fluroquinolones, only treating as long as is necessary to cure the infection

Question 38

What should severe C. difficile be treated with, if recurring change to what, only for an titial episode of non-severe infection

Answer 38

Vancomycin, fidaxomycin, metronidazole

Question 39

T/F: If a patient has S. typhi there should always be antibiotics used and if there is shig=toxin producing E. coli antibiotics should never be used

Answer 39

True

Question 40

How is levofloxacin/ciprofloxacin eliminated, azithromycin, ceftiaxone

Answer 40

Renal, liver, Renal/liver