Infectious Diarrhea DSA Flashcards by Liz Pennington

Who is at high risk for infectious diarrhea?

travelers

immunodeficient

daycare people

institutionalized people

consumers of certain foods (wtf?)

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What is the most important thing to look for on PE for infectious diarrhea?

signs of dehydration

mild: thirst, decreased fluid output
moderate: orthostatic BP, tenting, sunken eyes/fontanelle
severe: lethargy, hypotension, shock

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Acute infectious diarrhea is transmitted how?

fecal oral

(mild and self limited)

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when to work up infectious diarrhea?

profuse diarrhea with 6+ stools per day WITH dehydration

hypotension/tachycardia

fever

>48hrs without improvement

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What is the cornerstone of diagnosis for infectious diarrhea?

microbiologic analysis of the stool

routine studies: salmonella, shigella, E. coli, campylobacter

takes 24-48hrs

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What are some specific stool analyses?

special cultures for EHEC, Vibrio, and Yersina

PCR for C. diff

ova/parasites

protozoa antigens for giardia, crypto, E.histolytica

PCR antigen for rotovirus, norwalk

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When to suspect food poisoning?

summer-time, several sick members from picnic/banquet/restaurant

routine testing not done

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Common causes of food poisoning?

chicken (salmonella, campylobacter)

beef (EHEC)

fried rice (B. cereus)

potato salad (s. aureus)

lunch meats (listeria)

seafood (vibrio, norovirus)

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What is the micro of S. Aureus?

risk factors?

g+ cocci, preformed enterotoxins

watery diarrhea, N/V, onset within 6 hrs, better in 24-48

eggs, cream pastries, potato salad, mayo

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Micro of B. Cereus

risks

g+ rods, preformed enterotoxins

rapid onset vomiting, 6hrs of ingestion, watery diarrhea, better in 24-48 hrs

fried rice

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Micro for C. perfringens?

risks

g+ heat resistant spore forming rods with entertoxins

watery diarrhea, no vomiting

onset 6-18hrs, acid labile, better 24-48 hrs

beef, ham, poultry, legumes, gravy

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Micro of shigella

treat

risks

complications

g- rods, toxin mediated

bloody diarrhea, pus, fever, fecal leukocytes

difficult to differentiate from IBD

1-2wks long

bismuth, abx

lettuce raw veg.

reactive arthritis

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Micro of salmonella

risks

complications

gram -, infects peyers patches, non-typhoid in US

bloody diarrhea

stool culture

self limitied 5-10 days

eggs, poultry, reptiles, Sickle Cell

septic arthritis, abcess, osteomyelitis

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micro for salmonella typhi

gram-, anaerobic

typhoid fever, salmon/rose colored rash, pea soup poo, bradycardia

stool and blood cultures

fluoroquinolines

risks: travel, poor sanitation

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micro of C. jejuni

risks

complications

gram-, cruved, spiral rod

bloody diarrhea

fecal leukocytes

campy blood agar,

self limitied, 7 day illness

poultry

guillan barre

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V. cholorae micro

risks

treatment

gram-, anarobic, curved with flagella, toxin

rice water diarrhea, dehydration

stool micropscopy, gram stain

waterborn illness, seafood

rehydrate, vaccinate

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V. parahmolyticus micro

risks

gram-, cytotoxin, bacilli

N/V, blood diarrhea

self-limited

seafood

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Micro of V. vulnificus

risks

gram - bacilius

bullous skin lesions, cirrhosis, vomiting, diarrhea

coastal sea water, shellfish

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A. hhydrophila micro

risks

gram-, non-spore forming rod, flagella

two types cholera like-watery and bloody

ampicllin

fresh water fish/shelflfish, wound in water, nec fasc., gastroenteritis if swallowing water while diving/swimming

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Travellers diarrhea

recent travel

watery diarrhea

self limitied

often ETEC

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Micro of ETEC

Risks

gram - rod,

watery diarrhea

fecal leukocyte neg, clinical diagnosis

abx treatment

food/water esp in kids and elderly

EHEC micro

risks

complications

gram-, rod, shiga toxin

blood diarrhea, no fever

elevated leukocytes, shiga toxin

supportive, rehydration

undercooked burger

hus, more common in kids

EAEC is bloody or not bloody?

EPEC is blood or not bloody?

EIEC is blood or not bloody?

not bloody

both (infantile)

bloody

Y. enterocolitica micro

risks

complications

gram - coccobacilli

bloody diarrhea, right sided abd pain,

fecal leukocytes +

supportive care

deranged iron metabolism

reactive arthritis, erythema nodosum

L. monocytogenes micro sx dx tx risks complications

gram + rod non bloody diarrhea blood culture, no listeria in stool sample ampicillin pregnant woman issues with placenta, deli meats meningoencephalitis and listeria placentitis

Rotavirus micro sx dx tx risks

DSRNA, vomiting and watery diarrhea viral culture or PCR, wagon wheel appearance supportive care, vaccine infants and children, esp in winter

adenovirus micro dx dx tx risks

dsDNA fever, watery diarrhea and vomiting, eye issues viral culture supportive care children

Norovirus micro sx dx tx risk

small, naked RNA virus vomiting, watery diarrhea viral cultures usually unrevealing, fecal leuk. - supportive care older children and adults, nursing homes, schools, cruises

CMV mircro sx dx risks

dsDNA, linear fever, bloody diarrhea endoscopy with biopsy shows ulcerated lesions AIDS pts CD\<200

E. histolytica micro sx dx tx risks complications

trophozite, most common cause of dysentery bloody dairrhea, liver abscess flask shaped ulcer, ova and parasite stool or stool antigen crowded living, endemic areas, poor sanitation metronidazole toxic megacolon or pneumatosis coli

G. lamblia micro sx dx tx risks

4 flagella, 2 nuclei protozoan watery persistent diarrhea ova parasites, fecal leuk.-, stool antigen detection supportive care or metronidazole water, hiking campling, IgA def. more susceptible

C. parvum micro sx dx tx risks

4 motile sporozoites watery diarrhea stool ag detection or direct microscopy, modified acid fast staining, DFA resistant to chlorine treatment swimming pools

S. stercoralis micro sx dx tx risks

nemotode, enters through bare feet of asymptomatic, abd, vomiting, rash rhabditiform larvae in stool, eosinophils anti-helmintic

C. cayetanensis micro sx dx tx risks

produce, water even treated with Cl or I watery diarrhea can last up to 3wks fecal leuk-, oocytes in stool TMP-SMX,

C. belli micro sx dx tx risks

tropical and subtropical areas acute, non bloody, watery diarrhea may have eosinophilia, repeated stool examinations and concentration procedures are recomended may be seen in duodenal biopsy stained with modified acid fast tx with bactrim DS

What is a complication of ascaris lumbricoides

bowel obstruction

What is a complication of D. latum fish tapeworm ?

vitamin B12 def.

What is the 2nd most common cause of esophageal varices in africa?

Schistosoma mansoni causes bloody stools, bladder cancer, liver cysts

T. solium comes from what animal and can cause what severe problem?

pork, seizures

E. granulosus main carrier is what? forms what where?

comes from dogs forms cysts in liver or lungs "hydatid sand" on CT

What causes severe perianal itching?

E. vermicularis

What is general treatment and hydration rules for diarrhea due to ifnection?

hydration PO or IV to maintain electrolyte balance antimolitility agents can be used IF patient has no fever and nonbloody stools (not in EHEC or c. diff)

Best prevention of infectious diarrhea?

washing hands with soaps and waters alcohol based rubs are ineffective against norovirus and C. diff

PPx for travellers?

antibiotic prophylaxis for travelers is generally not recommended occasionally, will give cipro, azith, or rifaximin

What is reactive arthritis?

arthritis urethritis conjunctivitis (can come with salmonella, campylobacter, shigella, yersinia)

Pathogens that cayse watery stools typically affect which part of the bowel?

small bowel can cause weight loss, dehydration and malabsorption

Pathogens that cause blood and or wbc in the stool are typically located where?

in the large bowel

Which types of immunosuppressed patients are at greater risk of developing diarrhea?

lymphoma, bone marrow transplant, hiv, IgA def., hemochromatosis, AIDS with CD4\<200

What are opportiunistic infections in AIDS patients?

mycobacterium species, CMV, adenovirus, HSV, protozoa