Infectious Diarrhea and C. diff

Question 1

Patho of acute/watery diarrhea

Answer 1

Altered intestinal motility leads to less reabsorption of water and premature emptying of the colon

Question 2

Causative pathogens of acute/watery diarrhea

Answer 2

E. coli, rotavirus, V. cholerae

Question 3

Patho of dysentery

Answer 3

Altered ion transport where the normal ionic contents and osmolality is equal to the plasma

Question 4

Causative pathogens of dysentery

Answer 4

Shigella, salmonella, campylobacter, clostridium

Question 5

Causative pathogens of traveler’s diarrhea

Answer 5

E. coli, shigella, giardia, salmonella, viral causes

Question 6

Causative pathogens of acute viral gastroenteritis

Answer 6

Rotavirus, norovirus, parvovirus, adenovirus

Question 7

Causative pathogens of food poisoning

Answer 7

Staph, campylobacter, shigella, salmonella, clostridium

Question 8

Prevention of acute viral gastroenteritis

Answer 8

Wash hands, fruits, and vegetables; cook meat to recommended temperatures

Question 9

Treatment of food poisoning

Answer 9

Supportive care; can use antimotility agents in some patients

Question 10

Signs of acute/watery diarrhea

Answer 10

<10 episodes a day
Risk of severe dehydration
FOBT +

Question 11

Treatment of acute/watery diarrhea

Answer 11

Diarrhea stops with fasting

Question 12

Signs of persistent/dysentery diarrhea

Answer 12

> 10 episodes/day
FOBT+
Mild dehydration
Possible fevers

Question 13

Signs of traveler’s diarrhea

Answer 13

Travel followed by sudden onset watery diarrhea

Malaise, anorexia, abdominal cramps -> sudden, onset watery diarrhea

Question 14

Signs of enterotoxic E. coli

Answer 14

Diarrhea and abdominal cramping

No blood or pus in stool

Question 15

What is produced in enterotoxic E. coli?

Answer 15

Heat-labile and heat-stable toxins

Question 16

Treatment for traveler’s diarrhea: initial management

Answer 16

Symptomatic control and source control

Loperamide PRN x2 days

Question 17

Treatment for traveler’s diarrhea: high risk individuals

Answer 17

Bactrim x1-3 days

Question 18

Enterotoxic E. coli treatment

Answer 18

Ciprofloxacin x1-3 days

Rifaximin or azithro x1-3 days

Question 19

What is CI’ed in enterotoxic E. coli treatment?

Answer 19

Antimotility agents

Question 20

Mild water loss definition

Answer 20

<5% body weight loss
Alert but restless
Increased thirst
Moist to slightly dry mucous membranes
Normal/slightly decreased uurine output

Question 21

Moderate water loss definition

Answer 21

6-9% water loss
Lethargic and restless
Low BP, high HR
Dry mucous membranes
Delayed cap refill
Dark urine

Question 22

Severe water loss definition

Answer 22

>10% body weight loss
Drowsy, limp, loss of consciousness
Bradycardia
Cyanotic
Skin "tenting"
No urine production

Question 23

Treatment for mild-moderate water loss

Answer 23

PO replacement with glucose ORT, milk, rice ORT, Pedialyte

Question 24

Treatment for severe water loss

Answer 24

IV fluids like NS or lactated ringers

Question 25

Patho of C. diff infections

Answer 25

1. Exposure 2. Travels to large intestine 3. Maturation 4. Toxin production 5. Mucosal injury, intestinal fluid secretion, inflammation, cell death, pseudomembrane formation

Question 26

Risk factors for C. diff infection: patient-specific

Answer 26

Age >65, GI surgery, tube feeding, immunocompromised

Question 27

Risk factors for C. diff infections: facility-related

Answer 27

Length of stay, ICU admission, exposure

Question 28

Risk factors for C. diff infection: medication-related, highest risk ABX

Answer 28

Clindamycin, 3rd and 4th gen cephalosporins, fluoroquinolones, carbapenems

Question 29

Risk factors for C. diff infection: medication-related, lower risk ABX

Answer 29

Erythromycin, ampicillin, amoxicillin, pip/tazo

Question 30

Risk factors for C. diff infection: medication-related, lowest risk ABX

Answer 30

Aminoglycosides, vanco, metronidazole

Question 31

Non-severe C. diff disease: markers (lab values)

Answer 31

Leukocytosis (WBC ≤15,000 cells/ml) AND SCr <1.5 mg/dl

Question 32

Severe C. diff disease: markers

Answer 32

Leukocytosis OR SCr <1.5 mg/dl

Question 33

Fulminant C. diff disease: signs

Answer 33

hypotension or shock, ileus, megacolon

Question 34

AB-associated diarrhea without colitis manifestations

Answer 34

Mild to moderate (~6 loose BM/day) Crampy lower abdominal discomfort Slight lower abdominal tenderness

Question 35

AB-associated colitis without pseudomembranes

Answer 35

``` 10+ loss BM/day Fecal leukocytes Occult blood Nausea, anorexia, fever, malaise, dehydration, leukocytosis Abdominal distention, tenderness ```

Question 36

Pseudomembranous colitis

Answer 36

``` >10 BM/day Fecal leukocytes Occult blood Nausea, anorexia, fever, malaise, dehydration, electrolyte imbalance, leukocytosis Marked abdominal tenderness, distention ```

Question 37

C. diff clinical diagnostics

Answer 37

>3 unformed stools in 24 hours PLUS positive stool test for C. diff or toxins OR pseudomembranous colitis diagnosed by colonoscopy

Question 38

Initial, non-severe treatment of C. diff

Answer 38

Vanco 125mg PO QID x10 days Fidaxomicin 200mg PO BID x10 days Metronidazole 500mg PO TID x10 days

Question 39

Initial, severe treatment of C. diff

Answer 39

Vanco 125mg PO QID x10 days | Fidaxomicin 200mg PO BID x10 days

Question 40

Initial, severe, complicated treatment of C. diff

Answer 40

Vanco 500mg PO or NG QID (metronidazole 500mg IV added on if ileus is present)

Question 41

Alternate treatments for C. diff

Answer 41

Rifaximin 400mg TID x20 days as a vanco chaser for recurrence Actoxumab and bezlotoxumab Fecal microbiota transplantation

Question 42

First time recurrence of C. diff infection treatment

Answer 42

Use same treatments as initial treatment

Question 43

Second time recurrence of C. diff infection

Answer 43

Vanco taper or pulsed every other day

Question 44

C. diff infection prevention

Answer 44

Hand hygiene Contact precautions- gowns, gloves, patient isolation Environmental cleaning

Question 45

What should you avoid taking in a C. diff infection?

Answer 45

Antiperistaltic agents like loperamide and narcs, any concurrent ABX therapy if possible

Question 46

Leading cause of infectious diarrheal entities

Answer 46

Viral