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Infection > Infectious Diarrhoea > Flashcards

Infectious Diarrhoea Flashcards

1
Q

What is dysentery?

A

Large bowel inflammation, bloody stools

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2
Q

Causes of gastro-enteritis

A

Contamination of foodstuffs (intensively farmed chicken and campylobacter)
Poor storage of produce (Bacterial proliferation at room temperature)
Travel-related infections (salmonella)
Person-to-person spread (norovirus)

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3
Q

What is the most common bacterial pathogen in GI infection?

A

Campylobacter

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4
Q

Which pathogen causes most hospital admissions?

A

Salmonella

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5
Q

Defences against enteric infections

A

Hygiene
Stomach acidity (antacids and infection)
Normal gut flora (C. difficile diarrhoea)
Immunity (HIV + salmonella)

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6
Q

What are the types of clinical features of diarrhoeal illness?

A

Non-inflammatory/secretory (cholera)
Inflammatory (shigella dysentery)
Mixed picture (C. diff)

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7
Q

Non-inflammatory diarrhoeal illness

A

Secretory toxin-mediated

Frequent watery stools with little abdo pain

Rehydration mainstay of therapy

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8
Q

Mechanism of diarrhoea in cholera

A

Increased cAMP results in loss of Cl from cells along with Na and K

Osmotic effect leads to massive loss of water from the gut

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9
Q

Inflammatory diarrhoeal illness

A

PAIN AND FEVER

Inflammatory toxin damage and mucosal destruction

Bacterial infection/amoebic dysentery

Antimicrobials may be appropriate but rehydration alone is often sufficient

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10
Q

Fluid and electrolyte losses in secretory diarrhoea

A

Hyponatraemia due to Sodium loss with fluid replacement by hypotonic solutions

Hypokalaemia due to K loss in stool (40-80mmol/l of K in stools)

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11
Q

Infectious diarrhoea differential diagnosis

A

IBD
Spurious diarrhoea (secondary to constipation)
Carcinoma

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12
Q

Treatment of infectious diarrhoea

A

Oral rehydration with salt/sugar solution

IV saline

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13
Q

Campylobacter gastroenteritis post-infective sequelae

A

Guillain-Barre syndrome

Reactive arthritis

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14
Q

Routine bacterial culture

A

Difficult to find pathogen in the midst of complex normal flora

Selective and enrichment methods of culture necessary - variety of media and incubation conditions

Takes 3 days to complete all tests

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15
Q

Which two species of campylobacter are responsible for most infections?

A

C. jejuni

C. coli

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16
Q

What is prolonged carriage of salmonella associated with?

A

Gallstones

17
Q

How long after exposure to salmonella is symptom onset?

A

Usually <48hrs

18
Q

How long does diarrhoea last with salmonella gastroenteritis?

A

Usually <10 days

19
Q

What are the two species in the salmonella genus?

A

S. enterica

S. bongori

20
Q

How is E. coli illness typically characterised?

A

Frequent bloody stools

21
Q

What toxin is produced by E. coli?

A

Shiga toxin (also produced by shigella spp)

22
Q

Pathophysiology of E. coli infection

A

E. coli stays in the gut but the toxin travels to the blood which can cause haemolytic-uraemic syndrome (HUS)

23
Q

How is HUS characterised

A

Haemolytic anaemia
Renal failure
Thrombocytopenia

24
Q

Treatment of HUS

A

Supportive

Antibiotics NOT indicated

25
Q

When are antibiotics appropriate in gastroenteritis?

A

Immunocompromised

Severe sepsis or invasive infection

Chronic illness e.g. malignancy

(Not indicated for healthy patient with non-invasive infection)

26
Q

Treatment of C. diff

A

Metronidazole

Oral vancomycin

Fidaxomicin (new and expensive)

Stool transplants

Surgery may be required

27
Q

Presentation of C. diff infection

A

From mild diarrhoea to severe colitis

28
Q

What are the 4 C antibiotics that result in CDI?

A

Cephalosporins

Co-amoxiclav

Clindamycin

Ciprofloxacin

29
Q

UK protozoa

A

Giardia duodenalis
Cryptosporidium parvum
Entamoeba histolytica

30
Q

Long term complication of amoeba

A

Amoebic liver abscess

31
Q

WHat are the signs that diarrhoea is caused by sepsis outside of the gut?

A

Lack of abdo pain/tenderness goes against gastroenteritis
No blood/mucus in stools

32
Q

Which bacterial gastroenteritis presents most quickly?

A

Salmonella - <48 hrs after exposure

Campylobacter - up to 7 days

Infection (16 decks)

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