Infectious diarrhoea Flashcards
What is infectious diarrhoea?
Inflammation of mucous membranes of GI tract
Presentation of infectious diarrhoea
Diarrhoea
+/- abdo pain
Fever
Nausea and vomitting
How quick is onset of food poisonning with S.aureus toxin?
Within 12 hours - v fast
Bacterial infectious diarrhoea causes
E.coli
Cholera
Shigella
Salmonella
S.aureus
Campylobacter
Bacillus cerues
What bacteria that causes food poisonning is also ass with guillian barre syndrome?
Campylobacter
What causes parasitic infection adn onset?
Giardia
Amoebiasis
Non bloody causes of diarrhoea
E.coli
Giardiasis
Cholera
S.aureus
Bacilus
Bloody causes of diarrhoea
Shigella
Campylobacter
Amoebiasis
Shiga toxin producing e coli
Most common cause of travellers diarrhoer
E.coli followed by campylobacter
Symptoms of travellers diarrhoea
abdominal cramps, nausea, fever, headache and bloating.
Symptoms of C difficile
Watery diarrhoea
Cramping abdo pain
Nause
Fever
Severe dehydration
Blood/pus in stool
pseudomembranous colitis
What do you get iwth pseudomembranous colitis?
- Colon inflammation
- Diarrhoea
- Abdo pain
- Fever
- Distended colon and abdomen
- life threat
Risk factors for C difficile
PPI use
Over 65
Prev infection
What causes C.difficile infection
Antibiotics use disrupts gut micorbiota causing overgrowth of C difficile
Life threatening complications of c difficile
Hypotension
Ileus
Toxic megacolon
How long does viral diarrhoea last
2-3 days
Bacterial diarrhoea duration
3-7 dyasif untreated
Protozoal diarrhoea duration
Weeks to months without treatment
Red flags with acute diarrhoea
Blood in the stool.
Recent hospital treatment or antibiotic treatment
Weight loss.
Evidence of dehydration.
Nocturnal symptoms — organic cause more likely.
What are high risk groups for infectious diarrhoea?
Food handlers
Care home residents
Recent hospitilisaiton
Contacts with diarrhoea
Exposure to sources enteric infection eg meals out, petting zoo
Immunosupression
Signs of dehydration
increased pulse rate, reduced skin turgor, dryness of mucous membranes, delayed capillary refill time, decreased urine output, hypotension
Investigations bedside infectious diarrhoea
Abdo exam
PR exam
Stool sample - loose
Dehydration symptoms
-
Moderate dehydration
- Apathy/tiredness.
- Dizziness.
- Nausea/headache.
- Muscle cramps.
- Pinched face.
- Dry tongue or sunken eyes.
- Reduced skin elasticity.
- Postural hypotension.
- Tachycardia.
- Oliguria
Confusion -> coma
Bp <90
Hypovolaemic shock
How to do a stool sample if the person has travelled abroad, its prolonged or recurrent?
Suspicious for parasites - request ova, cysts and parasites tests seperately a minimum of two days apart
What to include on request form of stool sample for infectious diarrhoea?
Clinical features (for example fever; bloody stool; severe abdominal pain).
History of immunosuppression.
Food intake (for example shellfish).
Recent foreign travel (specify countries).
Recent antibiotic therapy, proton pump inhibitor therapy, or hospitalization (suggestive of Clostridium difficile infection).
Exposure to untreated water (suggestive of infection with protozoa).
Contact with other affected people, or an outbreak
When to admit patient with acute diarrhoea?
Vomitting and unable to retain oral fluids or signs of severe dehydration and shock
Influenced by:
Over 60
Home circumstances and support level
Fever
Bloody diarrhoea
Comorbidities eg immunosupression, IBD, DM, rheumatoid, renal impaired, SLE
Drugs - PPIs, steroids, immunosupressants ACEis, diuretics
Management of mild gastroenteritis
Advise on monitoring fluid intake and prevent/treat dehydration
Encourage regular fluid intake
Oral rehydration slat sl=olution as supplemental or with clinical features of dehydration
Give frequently in small doses after every loose motion
Drug treatment not routinely recommended
Advise should not attend work or other insitiutional/social settings for at least 48 hours after last episode
New features - safety net
Prevent transmission with hand washing with soap, cleaning surfaces that are often touched and washing soiled clothing and linen seperately to rest
When should OTC antidiarrhoeal drugs not be used?
Blood mucous or pus in stools
High fever
shigellosis confimred, probable or suspected, E coli stool culture and sensitivity
Treatment for gastroenteritis caused by giardiasis
Tinidazole 2g single dose
Contraindications for clarithromycin
severe hepatic impairment if renal impairment is also present.
Pregnant women, especially in the first trimester
Breastfeeding women
How to prescribe clarithromycin in people with renal impairment
use half normal dose if the estimated glomerular filtration rate (eGFR) is less than 30 mL per minute per 1.73 m2; maximum duration 14 days.
