Infectious diarrhoea Flashcards
What are the types of diarrhoea?
Secretory
Osmotic
Inflammatory
What are examples of causes of secretory diarrhoea?
Cholera
Enterotoxogenic E. coli
What causes diarrhoea in cholera?
Increased cAMP and Cl secretion
What are the clinical features of secretory diarrhoea?
Frequent watery stools with little abdominal pain
What can cause inflammatory diarrhoea?
Dysentery
What ae the clinical features of inflammatory diarrhoea?
Pain and fever
Inflammatory toxin damage and mucosal destruction
What can cause mixed diarrhoea?
C. diff
What is the most common cause of viral diarrhoea in under 5s?
Rotavirus
How is viral diarrhoea diagnosed?
Antigen detection
When is viral diarrhoea more common?
Winter
What is the most common cause of viral diarrhoea in adults?
Novovirus
What can cause gastro-enteritis?
Contamination of foodstuffs
Poor storage of foods
Travel related infections
Person to person
What is the common contamination of foodstuffs that ;eats to gastro-enteritis?
Chicken and campylobacter
What are the defences against enteric infections?
Hygiene
Stomach acidity
Normal flora
Immunity
What are the clinical features of gastro-enteritis?
Severe abdo pain
Dehydration
N&V
Diarrhoea
What is the usual presentation of salmonella gastro-enteritis?
Symptom onset <48 hours post exposure
Diarrhoea <10 days
What are the most common bacteria causing salmonella gastro-enteritis?
S. typhi
S. paratyphyi
How is diarrhoea assessed?
Symptoms and duration
Risk of food poisoning
Assess hydration
Features of inflammation
How is hydration assessed in diarrhoea?
Postural BP
Skin turgor
Pulse
What are the features of inflammation in diarrhoea?
Fever
What investigations can be done for diarrhoea?
Bloods Blood culture Stool culture Renal function Abdo xray if distension
What is he differential diagnosis with diarrhoea?
IBD
Spurious (overflow) diarrhoea
Carcinoma
Sepsis
What is the treatment of diarrhoea?
Rehydration
Antimicrobials in certain situations
What are the indications for antimicrobial treatment with diarrhoea?
immunocompromised severe sepsis or invasive infection valvular heart disease chronic illness diabetes
What is the treatment of C diff?
Stop any unnecessary antibiotics
Metronidazole or oral vancomycin if severe/metronidazole not effective
Stool transplant
Surgery
What are the common precipitation antibiotics for C diff?
Co-amoxiclav
Ceftriaxone
Clindamycin
Ciprofloxacin
What can cause haemolytic uraemic syndrome?
E. coli
What is the treatment of haemolytic uraemic syndrome?
No antibiotics
Supportive care- up to and including dialysis
What could cause osmotic diarrhoea?
Malabsorption- coeliac, pancreatic disease
