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Infection > Infectious Diarrhoea > Flashcards

Infectious Diarrhoea Flashcards

1
Q

What is definition of gastro-enteritis?

A

3+ stools in 24 hrs PLUS one of fever, vomit, pain, blood/mucus stool

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2
Q

What is dysentery?

A

Large bowel inflammation + bloody stools

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3
Q

What are causative mechanisms of diarrhoea?

A

Toxins, invasion, others

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4
Q

What are defences against diarrhoea?

A

Age, hygiene, gastric acid, gut motility, gut immunity, normal flora

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5
Q

What are the 3 types of diarrhoea?

A

Non-inflammatory, Inflammatory, Mixed

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6
Q

What is non-inflammatory (secretory) diarrhoea? What is the treatment?

A

Toxin mediated
Watery stools, rapid dehydration
Tx = rehydration

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7
Q

What is inflammatory diarrhoea?

Treatment?

A

Bacterial infection
Inflammatory + toxin damage and mucosal destruction
Causes abdominal pain, fever, bloody stools, systemic upset
Tx = rehydration +/- antimicrobials

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8
Q

What is an example mixed diarrhoea?

A

C. difficile

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9
Q

What is the most common bacterial pathogen causing diarrhoea

A

Campylobacter

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10
Q

What pathogen causes the most hospital admissions due to diarrhoea?

A

Salmonella

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11
Q

Causes of infectious diarrhoea?

A

Contamination of foodstuffs e.g. chicken, poor food storage, travel related, person-to-person transmission

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12
Q

Patient assessment, what symptoms do you ask about?

A

Duration, frequency, consistency of diarrhoea

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13
Q

What risk factors are there for diarrhoea?

A

Food poisoning, occupation, travel, antimicrobials

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14
Q

What do you check on examination of a patient with diarrhoea?

A

Hydration status- BP, pulse, urine flow, skin turgor, muscle cramps

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15
Q

What are features of inflammation on a patient?

A

Fever, raised WCC

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16
Q

When is gastro-enteritis unlikely?

A

If diarrhoea present for over 2 weeks

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17
Q

What consequences are there due to fluid + electrolyte loss?

A

Severe dehydration (1-7 litres of fluid lost per day)
Hyponatraemia (sodium loss during fluid replacement with hypotonic solutions)
Hypokalaemia ( K+ loss in stool)

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18
Q

What investigations should be done?

A

Stool + blood culture, blood count (neutrophilia, haemolysis), renal function, sigmoidoscopy, abdo x-ray if distended, serology

19
Q

Differential diagnosis?

A

Diarrhoea as a response to sepsis
IBD (duration > 2 weeks)
Spurious diarrhoea secondary to constipation
Carcinoma

20
Q

Treatment for diarrhoea?

A 
Oral rehydration - with salt / sugar
IV saline
Antimicrobials
Fasting
Treat complications
21
Q

What are the features of campylobacter infection? (C. jejuni)

A

Incubation of up to 7 days, infection clears within 3 weeks (but can have positive stool test up to 6 weeks0
SEVERE abdo pain, +/- colitic picture
Rarely invasive
Post invective sequelae: Guillain barre syndorme, Reactive arthritis

22
Q

What are the features of salmonella infection?

A 
Symptom onset <48 h after exposure
Diarrhoea lasts < 10 days
<5% have positive blood culture
20% have positive stools at 20 weeks
27% experience IBS symptoms 6 months after
23
Q

What are the features of E.Coli 0157?

A

Infection from e.g. contaminated meat/ Cattle reservoir
Frequent bloody stools
Produce a shiga-like toxin (SLT)
E. coli O157 stays in the gut but the toxin gets into the blood
Enterohaemorrhagic: haemorrhage within intestines

24
Q

What toxin can cause HUS and what is HUS?

A

The shiga like toxin (SLT)
HUS = Haemolytic uremic syndrome
Causes haemolytic anaemia (caused by destruction of blood cells) + acute renal failure

25
Q

What are the features of Shigella?

A

largely a childhood / travel disease
HUS and seizures can complicate it
Different serotypes set back development of a vaccine for Shigella

26
Q

What other forms of E. Coli cause diarrhoea?

A

enteropathogenic
enterotoxic
enteroinvasive

27
Q

What bacterial pathogens cause food poisoning?

A

Stap aureus
Bacillus cereus
Clostridium perfringens

28
Q

What are the main pathogens of traveller’s diarrhoea?

A

Enterotoxigenic E. coli, campylobacter, shigella

29
Q

How are parasites diagnosed?

A

By microscopy + PCO (parasites, cysts and ova tests)

30
Q

Describe the features of rotavirus + its diagnosis?

A

Common in winter + children <5 years
Diagnosis by antigen detection
(note: Rotavirus vaccine used in developing world)

31
Q

Describe the features of norovirus?

How is it diagnosed?

A

Faecal-oral transmission
winter vomiting disease
VERY infectious, common cause of outbreaks in hospitals + cruise ships

Diagnosis: PCR

32
Q

Give two examples of intestinal parasites

A

Cryptosporidiosis

Giardia Lamblia

33
Q

What are the features of cryptosporidiosis?

A

Caused by water-borne outbreaks (cattle = principal reservoir)
Cysts seems on microscopy
Self limiting, No Tx

34
Q

What are the features of Giardia Lamblia?

A

present in contaminated water
causes diarrhoea, malabsorption, failure to thrive
Cysts seen on microscopy
Tx = metronidazole, tinidazole

35
Q

Give an example of an imported parasite + describe its features

A 
Entamoeba histolytica
= Amoebic dysentery
Cysts seen in asymptomatic patient
Long term Cx= amoebic liver abscess
Microscopy only 50% sensitive
May mimic Ulcerative Colitis
36
Q

What is the treatment for Amoebic dysentery?

A

10 days of metronidazole

37
Q

What is an antibiotic associated diarrhoea?

A

Clostridium difficile infection

38
Q

Describe the features of a Clostridium difficile infection (CDI)

A

Overgrowth of C. diff + production of toxins A (enterotoxin) and toxin B (cytotoxin)

39
Q

What are the symptoms of a CDI?

A

Severity ranges from mild diarrhoea to severe colitis

40
Q

What are the investigations for CDI?

A

Sigmoidoscopy, stool culture, toxin detection (33% false negative)

41
Q

What is the treatment for CDI?

A
  1. Metronidazole
  2. Oral vancomycin (give if 2 or more severity markers)
  3. Fidaxomicin
42
Q

How do you prevent CDI?

A

Reduction in broad spectrum antibiotics prescribing
Avoid the 4 C’s: Cephalosporins, co-amoxiclav, clindamycin, clarithromycin

Isolate symptomatic patients
Prevention with biotherapy

43
Q

For what pathogens are routine bacterial cultures done?

A

Campylobacter + Salmonella

44
Q

What indications are there for giving antibiotics?

A

Immunocompromised patients, severe sepsis, valvular heart disease, diabetes, chronic illness

Infection (12 decks)

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