Infectious Diarrhea Unrein Flashcards
pt has been on abx, what kind of diarrhea did they probably get?
c difficile
especially if clindamycin
what do we order to check for c diff?
PCR
toxins A & B are 63-94% sensitive
how do we treat c diff?
metronidazole is the drug of choice due to cost
vancomycin, fidaxomicin other choices
refractory? fecal transplant. 1/3 right colon, 2/3 left colon
prevent spread of c diff?
hand washing, not just alcohol (spore-forming)
etiology of bleeding in c diff
gut flora makes vitamin K, coagulation factors go down
guy with hodgkin’s on chemotherapy, what kind of diarrhea does he have?
cryptosporidium parvum- opportunistic infection for immune compromised
other immune compromised ones: Isospora and cyclospora, CMV, mycobacterium.
Anything that can normally cause diarrhea too.
how to diagnose cryptosporidium?
acid fast stain OR stool antigen
no medical problems, 2 days of watery diarrhea
no blood
mild abdominal cramping, afebrile.
Most appropriate next step?
nothing, it will probably resolve on its own
not an inflammatory diarrhea. If severe cramping or tenesmus, fever or blood– likely inflammatory, work up higher yield
kids in daycare have diarrhea, no respiratory problems. What kind of diarrhea likely?
rotavirus
rice water stools, shape of bacteria?
vibrio cholera
comma shapped gram positive
does cholera recur?
it can. Antibodies wear off after about 6 months or so.
most common cause of diarrhea in the country?
campylobacter
causes a bloody diarrhea
daycare, bloody diarrhea, high fever
shigella; most viral illnesses don’t cause fever that high
management options of shigella
abx, reduces shedding and duration
pneumonia, nursing home, amoxicillin/ clavulanate. What kind of diarrhea?
abx-induced diarrhea.
bloody diarrhea, fever, HUS. What kind of E Coli?
0157:H7 EHEC enterohemorrhagic
guy ate hamburger and raw oysters. watery diarrhea without blood. What organism do we suspect?
Vibrio, because it’s non bloody
trip to India, liver mass, diarrhea. What organism?
entamoeba histolytica
schistosomiasis
causes malaise, diarrhea, weight loss and hepatosplenomegaly, but not a hepatic abscess
giardia
non bloody diarrhea
prolonged diarrhea of weeks to months, malabsorption with weight loss
entamoeba histolytica
common in developing countries
liver is most common site for extraintestinal disease
how to treat entamoeba?
metronidazole
no booze.
restaurant, recent trip back from Vietnam, enlarged spleen, fever 103, relative bradycardia, bloody and mucousy diarrhea, malaise, maculopapular rash over chest and abdomen
salmonella typhi
Don’t give abx! Prolong the carrier state and shedding.
watery diarrhea, intestinal cramping without blood. Ate a hamburger 3 days ago, ate at her parents’ asian food restaurant yesterday. causeative organism, pick one:
bacillus cereus E Coli EHEC o157:H7 Vibrio vulnificus Norovirus Giardia lamblia
bacillus cereus- rice
12-48 hour incubation period
bloody diarrhea, raw hamburger. Shape of organism?
E. Coli
Gram negative rods
gram positive rods, what?
clostridia
Phenolphthalein
in a lot of laxatives
laxative abuse is a weight loss thing
can be attention-seeking behavior
diagnosis of exclusion easy to miss
staph aureus
does not cause bloody diarrhea
disease results due to preformed toxin with an onset of 2-6 hours
meds that can cause diarrhea
PPIs (also increase risk of c diff due to lack of acid, affect vitamin D absorption)
antidepressants
watery diarrhea, trip to mexico, chinese restaurant, no fever or blood. Likely cause?
ETEC
traveller’s diarrhea
weeks ago camping trip foul smelling diarrhea now, anorexia and weight loss
giardia
how to prevent giardia
boil water 3-5 minutes, or use iodine treatment, or bottled water
associated with beavers
how to dx giardia
look at stool for ova and parasites
unpasteurized goat milk. What diarrhea?
fever, sore throat, bloody diarrhea and RLQ pain
yersinia enterocolitica
mimics appendicitis
HIV
low CD4 count
basophilic intranuclear inclusion bodies
CMV
