Infectious diarrhoea

Question 1

What is infectious diarrhoea?

Answer 1

Inflammation of mucous membranes of GI tract

Question 2

Presentation of infectious diarrhoea

Answer 2

Diarrhoea
+/- abdo pain
Fever
Nausea and vomitting

Question 3

How quick is onset of food poisonning with S.aureus toxin?

Answer 3

Within 12 hours - v fast

Question 4

Bacterial infectious diarrhoea causes

Answer 4

E.coli
Cholera
Shigella
Salmonella
S.aureus
Campylobacter
Bacillus cerues

Question 5

What bacteria that causes food poisonning is also ass with guillian barre syndrome?

Answer 5

Campylobacter

Question 6

What causes parasitic infection adn onset?

Answer 6

Giardia
Amoebiasis

Question 7

Non bloody causes of diarrhoea

Answer 7

E.coli
Giardiasis
Cholera
S.aureus
Bacilus

Question 8

Bloody causes of diarrhoea

Answer 8

Shigella
Campylobacter
Amoebiasis
Shiga toxin producing e coli

Question 9

Most common cause of travellers diarrhoer

Answer 9

E.coli followed by campylobacter

Question 10

Symptoms of travellers diarrhoea

Answer 10

abdominal cramps, nausea, fever, headache and bloating.

Question 11

Symptoms of C difficile

Answer 11

Watery diarrhoea
Cramping abdo pain
Nause
Fever
Severe dehydration
Blood/pus in stool
pseudomembranous colitis

Question 12

What do you get iwth pseudomembranous colitis?

Answer 12

• Colon inflammation
• Diarrhoea
• Abdo pain
• Fever
• Distended colon and abdomen
• life threat

Question 13

Risk factors for C difficile

Answer 13

PPI use
Over 65
Prev infection

Question 14

What causes C.difficile infection

Answer 14

Antibiotics use disrupts gut micorbiota causing overgrowth of C difficile

Question 15

Life threatening complications of c difficile

Answer 15

Hypotension
Ileus
Toxic megacolon

Question 16

How long does viral diarrhoea last

Answer 16

2-3 days

Question 17

Bacterial diarrhoea duration

Answer 17

3-7 dyasif untreated

Question 18

Protozoal diarrhoea duration

Answer 18

Weeks to months without treatment

Question 19

Red flags with acute diarrhoea

Answer 19

Blood in the stool.
Recent hospital treatment or antibiotic treatment
Weight loss.
Evidence of dehydration.
Nocturnal symptoms — organic cause more likely.

Question 20

What are high risk groups for infectious diarrhoea?

Answer 20

Food handlers
Care home residents
Recent hospitilisaiton
Contacts with diarrhoea
Exposure to sources enteric infection eg meals out, petting zoo
Immunosupression

Question 21

Signs of dehydration

Answer 21

increased pulse rate, reduced skin turgor, dryness of mucous membranes, delayed capillary refill time, decreased urine output, hypotension

Question 22

Investigations bedside infectious diarrhoea

Answer 22

Abdo exam
PR exam
Stool sample - loose

Question 23

Dehydration symptoms

Answer 23

• 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

Question 24

How to do a stool sample if the person has travelled abroad, its prolonged or recurrent?

Answer 24

Suspicious for parasites - request ova, cysts and parasites tests seperately a minimum of two days apart

Question 25

What to include on request form of stool sample for infectious diarrhoea?

Answer 25

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

Question 26

When to admit patient with acute diarrhoea?

Answer 26

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

Question 27

Management of mild gastroenteritis

Answer 27

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

Question 28

When should OTC antidiarrhoeal drugs not be used?

Answer 28

Blood mucous or pus in stools
High fever
shigellosis confimred, probable or suspected, E coli stool culture and sensitivity

Question 29

Treatment for gastroenteritis caused by giardiasis

Answer 29

Tinidazole 2g single dose

Question 30

Contraindications for clarithromycin

Answer 30

severe hepatic impairment if renal impairment is also present.
Pregnant women, especially in the first trimester
Breastfeeding women

Question 31

How to prescribe clarithromycin in people with renal impairment

Answer 31

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.