Infectious Diarrhea - You're better off memorizing the lists of bugs off the powerpoint. Flashcards
Dx criteria for evaluation of diarrhea
temp >103F, tenesmus, bloody diarrhea, prolonged course >=2 weeks
4 virulence factors for bacteria that lead to diarrhea
adherence, enterotoxin, cytotoxin, mucosal invasion
Cholera toxin A
endocytosed and increases cAMP and increases fluid that is pumped out in the crypts
Cholera toxin B
toxin increases cAMP and reduces absorption of sodium at surface of enterocyte
Clostridium cytotoxins A/B
endocytosed –> glycosylate rho –> weakening of tight junctions + inflammation –> cytotoxicity
Name the bugs: food borne outbreak
salmonella, shiga, E-coli,
Name the bugs: water-borne
vibrios, giardia, crypto
Name the bugs: seafood, shellfish
vibrio, noro, salmonella
Name the bugs: poultry
campylobacter, salmonella
Name the bugs: beef, sprouts
shiga-E coli, EHEC
Name the bugs: eggs
salmonella
Name the bugs: mayo and cream
staph, clostridium, salmonella
Name the bugs: pie
salmonella, campylobacter, crypto, giardia
Name the bugs: antibiotics
c. diff
Name the bugs: person to person
shigella, rota
Name the bugs: non bloody viral diarrhea
noro, rota, adeno, astro, toro
Symptoms of noro
diarrhea, vomiting, cramps, headache
How long does noro last?
24-72 hours
Mode of transfer: noro
fecal-oral
Tx of noro
supportive
Symptoms of rota
vomiting + watery diarrhea
who gets rota?
kids
Mode of transfer: rota
fecal-oral
Tx of rota
supportive, anti-rota Ig
Prevention of rota
breastfeeding, rotateq/rotarix
How long does rota last
5-7 days
Symptoms of adeno
diarrhea, vomiting, fever
Tx of adeno
supportive
Duration of adeno
5-12 days
Who gets adeno?
babies and immunocompromised
Which adeno serotypes cause diarrhea?
40 and 41
Symptoms of astro
watery diarrhea
Duration of astro
1-4 days
Tx of astro
supportive
Who gets astro?
children < 7
How does astro transmit?
fecal oral
Who gets toro
cows and children
Symptoms of toro
watery diarrhea, bloody with vomiting
Duration of toro
5-7 days
Tx of toro
supportive
Name the bugs: non-bloody bacterial diarrhea, food borne
enterotoxigenic Ecoli, diffusely adhering Ecoli, vibrio, non-cholera vibrio
Name the bugs: non-bloody bacterial diarrhea, non-food borne
aeromonas, bacterioides fragilis, diffusely adhering E.coli
Name the bugs: non-bloody parasitic diarrhea, non-food-borne
dientamoeba, blastocystis, strongyloides
Name the bugs: non-bloody parasitic diarrhea, food borne
giardia, crypto, cyclo, trichella
Name the bugs: bloody infectious diarrhea, food-borne bacteria
shigella, salmonella, campylobacter, shiga-ecoli, yersinia
Name the bugs: bloody infectious diarrhea, non-food-borne bacteria
c. diff
Name the bugs: bloody infectious diarrhea, parasites
entamoeba histolytica, schistosomiasis
Name the bugs: looks like bloody infectious diarrhea but isn’t –> proctitis symptoms = mucoid stool, small volume, rectal pain
shigella, gonorrhea, treponema, chlamydia, herpes 2
Food-borne toxin mediated diarrhea
clostridium perfringens, staph aureus, bacillus cereus, botulinum, anthracis
Name the bugs: immunosuppressed non bloody parasites
microsporidia, crypto, cyclo, iso, mycobacterium avium, strongyloides
Name the bugs: immunosuppressed bloody viruses
cmv, hsv proctitis
Name the bugs: traveler’s diarrhea bacteria
e coli, campylobacter, salmonella, shigella, aeromonas, plesiomonas, vibrio
Name the bugs: traveler’s diarrhea viruses
noro, rota, adeno, astro
Name the bugs: traveler’s diarrhea parasites
giardia, entamoeba histolytica, crypto, cyclo
What is a hospitalized patient?
admitted and been in the hospital for 3 days –> c diff
Dx of acute diarrhea
fecal leukocytes/lactoferrin/calprotectin, cbc, stool culture, stool ova and parasites, stool cdiff + a bunch of organism specific studies
Classic C diff effect on intestine
pseudeomembranous colitis
3 kinds of chronic diarrhea
fatty, secretory, inflammatory
Name the bugs: chronic inflammatory diarrhea- viral
cmv, hsv proctitis
Name the bugs: chronic inflammatory diarrhea- bacterial
c diff, aeromonas, yersinia, salmonella, campylobacter, tb, gonorrhea, tremponema, chlamydia
Name the bugs: chronic inflammatory diarrhea- parasites
Entamoeba histolytica, strongyloides, schistosomiasis
Whipple’s disease - what is it? symptoms?
chronic malabsorptive diarrhea, weight loss, watery stools, low fever, hyperpigmentation, cardiac and neurologic stuff
Tx of Whipple’s
penicillin G, 3rd gen cephalosporin, brain antibiotic for a year
Name the bugs: chronic inflammatory malabsorptive diarrhea
whipples, giardia
Name the bugs: chronic inflammatory secretory diarrhea
crypto, cyclo, micro, iso
4 blood tests standard for chronic diarrhea
cbc, metabolic panel, tsh, celiac ab
4 stool tests for chronic diarrhea
c diff, o and p (crypto and giardia), culture (aeromonas), fecal fat
A low stool gap suggests what kind of diarrhea?
secretory <50 stool gap
A high stool gap suggests what kind of diarrhea?
> 100 = osmotic source of diarrhea
Hemolytic Uremic Syndrome
antibiotic therapy does not decrease morbidity due to EHEC –> may increase risk of HUS –> avoid ab in EHEC