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Infection > Infectious diarrhoea > Flashcards

Infectious diarrhoea Flashcards

1
Q

What is the objective definition of gastro-enteritis?

A

Three or more loose stools/day

Accompanying features

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2
Q

What are the obvious features of dysentery?

A

Large bowl inflammation

Bloody stools

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3
Q

What are examples of the epidemiology of gastro-enteritis?

A

Contamination of foodstuffs - chicken and campylobacter
Poor storage of produce - bacterial proliferation at room temperature
Travel-related infections
Person-to-person spread - norovirus

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4
Q

What is the commonest cause of gastro-enteritis?

A

Viruses

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5
Q

What is the commonest bacterial pathogen causing gastro-enteritis?

A

Campylobacter

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6
Q

What is the pathogen which causes the most hospital admissions per year?

A

Salmonella

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7
Q

Which type of food is linked to the most cases of food poisoning per year?

A

Poultry meat

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8
Q

In order, what are the most common pathogen isolates in Scotland?

A

Campylobacter
Salmonella
E.coli O157

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9
Q

What are the best defences against enteric infections?

A

Hygiene
Stomach acidity
Normal gut flora
Immunity

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10
Q

Why are you at more risk of gastro-enteritis if on antacids?

A

Lose protection of the acidity of the stomach

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11
Q

Why might you get diarrhoea if you are on antibiotics for C.diff?

A

Taking antibiotics can kill “good” bacteria, allowing C. difficile to multiply and release toxins that damage the cells lining the intestinal wall, causing diarrhoea, abdominal pain, and fever as well as other symptoms

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12
Q

Which group of patients are particularly susceptible to salmonella infections?

A

Immunosuppressed e.g. HIV

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13
Q

What are the different categories of clinical features of diarrhoeal illness?

A

Non-inflammatory
Inflammatory
Mixed picture

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14
Q

What is an example of a non-inflammatory/secretory diarrhoeal illness?

A

Cholera

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15
Q

What is the character of a non-inflammatory/secretory diarrhoeal illness?

A

Lots of watery diarrhoea

Little abdo pain

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16
Q

What is an example of an inflammatory diarrhoeal illness?

A

Shigella dysentery

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17
Q

What is the character of an inflammatory diarrhoeal illness?

A

Inflammatory toxin damage and mucosal destruction
Pain and fever
More systemic upset
Tender abdomen

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18
Q

What is the mechanism of diarrhoea in cholera (non-inflammatory)?

A

Bacterial toxins activate adenyl cyclase and cAMP is made
Increased cAMP levels result in loss of Cl from cells along with Na and K
Osmotic effects leads to massive loss of water from the gut

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19
Q

What is the treatment for non-inflammatory and inflammatory diarrhoeal illness?

A

Oral rehydration therapy

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20
Q

What factors should be considered when assessing a patient with diarrhoeal illness?

A

Symptoms and duration - >2wks unlikely infective gastro-enteritis
Risk of food poisoning
Assess hydration - postural BP, skin turgor, pulse
Features of inflammation - fever, raised WCC

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21
Q

Postural drop is defined as a reduction in systolic BP by how much?

A

20mmHg

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22
Q

What are the clinical signs in a paediatric patient with diarrhoeal illness?

A 
Sunken eyes and cheeks
Decreased skin turgor
Sunken fontanelles
Few or no tears
Dry tongue or month
Sunken abdomen
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23
Q

In which subtype of diarrhoea can fluid and electrolyte losses be particularly severe?

A

Secretory/non-inflammatory diarrhoea

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24
Q

How much fluid can be lost /day in a patient with secretory diarrhoea?

A

1-7L

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25
Q

How can a patient with diarrhoeal illness have hypokalaemia?

A

Due to K loss in stool

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26
Q

What investigations can you do for a patient with diarrhoeal illness?

A

Stool culture +/- molecular of Ag testing
Blood culture
Renal function
Blood count: neutrophilia, haemolysis (E.coli O157)
Abdominal XR/CT if abdomen distended/tender

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27
Q

What might a stool antigen test look for?

A

H.pylori infection

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28
Q

What are some differential diagnoses for diarrhoeal illness?

A

IBD (blood in stool)
Spurious diarrhoea
Carcinoma
Sepsis outside the gut

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29
Q

What is spurious diarrhoea?

A

Chronic constipation causes the bowel to be blocked by hard-packed faeces, some liquid manages to pass = spurious diarrhoea
Common in elderly

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30
Q

What are the signs that diarrhoea and fever are being caused by sepsis outside the gut?

A

Lack of abdomen pain/tenderness (goes against gastroenteritis)
No blood/mucus in stools (goes against IBD)

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31
Q

What is the common treatment of gastro-enteritis?

A

Oral rehydration with salt/sugar solution

IV saline

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32
Q

How long can campylobacter gastroenteritis be incubated?

A

Up to 7 days

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33
Q

After how many weeks would the stools be negative for campylobacter infection?

A

Within 6 weeks

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34
Q

What is the commonest bacterial cause of gastroenteritis?

A

Campylobacter infection

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35
Q

What are differential diagnoses for abdominal pain caused by gastroenteritis?

A

Appendicitis

Perforation

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36
Q

What post-infectious complications can occur as a result of campylobacter gastroenteritis?

A

Guillain-Barre syndrome

Reactive arthritis

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37
Q

How long does it take to complete all tests for bacterial cultures to find pathogens responsible for diarrhoeal illnesses?

A

3 days

38
Q

What types of detection are used to find bacterial pathogens?

A

Molecular detection

Antigen detection

39
Q

What are the two species of campylobacter which cause the most infections?

A

C.jejuni

C.coli

40
Q

What is the commonest cause of bacterial food poisoning in the UK?

A

Campylobacter

41
Q

What may contain campylobacter which may cause infection?

A

Chicken, contaminated milk, puppies

42
Q

What pathogen type of gastroenteritis is more likely to hospitalise a patient?

A

Salmonella gastroenteritis

43
Q

When is the symptom onset usually for salmonella gastroenteritis?

A

<48 hrs after exposure

44
Q

How long do diarrhoeal symptoms usually last for salmonella gastroenteritis?

A

<10 days

45
Q

What percentage of salmonella gastroenteritis have positive blood cultures?

A

<5%

46
Q

What may prolonged carriage of positive blood cultures in stools be associated with?

A

Gallstones

47
Q

What is a common complication of salmonella gastroenteritis?

A

Post-infectious irritable bowel

48
Q

How is the character of IBD differentiated from the character of salmonella gastroenteritis?

A

IBD: few loose sttols in morning, better rest of day
SGE: up during night and all day

49
Q

What are the two species of salmonella in the genus?

A

S.enterica

S.bongori

50
Q

What are the commonest salmonella isolates in the UK?

A

S.enteritidis

S.typhimurium

51
Q

How does E.coli infection spread?

A

Contaminated meat

Person-to-person

52
Q

How is E.coli O157 typically characterised?

A

Frequent bloody stools

53
Q

What toxin does E.coli O157 produce?

A

Shiga toxin

54
Q

How does the toxin spread?

A

E.coli O157 stays in gut, toxin gets into the blood

55
Q

What syndrome can the shiga toxin cause?

A

Hemolytic-uraemic (HUS) syndrome

56
Q

What does hemolytic-uraemic (HUS) syndrome cause?

A

Haemolytic anaemia
Renal failure
Thrombocytopenia

57
Q

What is the treatment for hemolytic-uraemic (HUS) syndrome?

A

Mainly supportive
Dialysis
No antibiotics
Plasmapharesis/IVIG

58
Q

What are the symptoms of hemolytic-uraemic (HUS) syndrome?

A 
Abdominal pain
Bloody diarrhoea
Fever
Seizures
Lethargy
59
Q

How does Shiga toxin cause HUS?

A

Shiga toxin can enter your bloodstream and cause damage to your blood vessels

60
Q

What are other bacteria which can cause diarrhoeal illness?

A

Shigella

E.coli - other forms

61
Q

What are the 4 species of Shigella?

A

S.sonnei
S.flexneri
S.boydii
S.dysenteriae

62
Q

What are other bacterias that cause food poisoning outbreaks?

A 
Staph aureus
Bacillus cereus (re-fried rice)
Clostridium perfringens (undercooked meat left out)
63
Q

When are antibiotics indicated for patients with gastroenteritis?

A

Immunocompromised
Severe sepsis or invasive infection
Chronic illness (malignancy)

64
Q

With what history should you suspect a patient has C.diff diarrhoea?

A

History of previous antibiotic treatment

65
Q

What are the treatments for C.diff diarrhoea?

A 
Metronidazole
Oral vancomycin
Fidaxomicin
Stool transplants
Surgery
66
Q

Why is oral vancomycin usually ineffective and why is it effective in C.diff diarrhoea?

A

Oral vancomycin usually ineffective as doesn’t pass through semi-permeable membranes
In C.diff diarrhoeal illness oral vancomycin is good as it stays in the gut

67
Q

What 4 C’s (anitbiotics) should be avoided to avoid C.diff infection?

A

Cephalosporins
Co-amoxiclav
Clindamycin
Ciprofloxacin

68
Q

How can C.diff infections be prevented?

A

Avoid 4C’s
Reduction in broad spectrum antibiotic prescribing
Antimicrobial management team (AMT) and local antibiotic policy
Isolate symptomatic patients
Hand hygiene
Cleaning environment

69
Q

How are C.diff infections managed?

A

Stop precipitating antibiotic
Treatment algorithm - oral metronidazole
Oral vancomycin if 2+ severity markers

70
Q

How are parasitic infections usually diagnosed?

A

Microscopy

71
Q

How should a stool request be sent for a suspected parasitic infection?

A

Parasites, cysts and ova

P,C&O

72
Q

What parasite causes giariasis?

A

Giardia duodenalis

73
Q

What are the symptoms of a giardia duodenalis infection/giardiasis?

A

Diarrhoea
Gas
Malabsorption
Failure to thrive

74
Q

How is giardia duodenalis transmitted?

A

Direct contact with cattle/dogs/cats/other people

Food/water contaminated with faeces

75
Q

How is giardia duodenalis detected?

A

Cysts seen on stool microscopy
String test
Trophozoites seen on duodenal biopsy

76
Q

How is giardiasis treated?

A

Metronidazole

77
Q

What are the symptoms of a Cryptosporidium parvum infection?

A

Diarrhoea
Nausea and vomiting
Abdominal pain

78
Q

How is Cryptosporidium parvum carried?

A

> 150 species of animals

79
Q

How is Cryptosporidium parvum infection spread?

A

Infected animals/faeces

Contaminated water/food

80
Q

How is Cryptosporidium parvum diagnosed?

A

Oocysts seen on microscopy

81
Q

What does Entamoeba histolytica cause?

A

Amoebic dysentery
Invasive extraintestinal amoebiasis
Usually no bowel symptoms

82
Q

How is an Entamoaeba histolytica infection diagnosed?

A

Microscopy: trophozoites or cysts

Antibody detection in serum

83
Q

How is an Entamoaeba histolytica infection treated?

A

Metronidazole

Luminal agent to clear colonisation

84
Q

What is a long term complication of Entamoaeba histolytica infection?

A

Amoebic liver abscesses

85
Q

What are viral diarrhoea causes?

A

Rotavirus
Norovirus
Adenovirus

86
Q

What is the diagnostic test for rotavirus?

A

Antigen detection in stool

87
Q

What age are patients who usually get rotavirus?

A

<5yrs

88
Q

When do babies get the rotavirus vaccine?

A

2 doses:
8 weeks
12 weeks

89
Q

What virus is a common cause outbreaks?

A

Norovirus

90
Q

Where are norovirus outbreaks most likely to occur?

A

Hospitals
Community: schools, care homes
Cruise ships

91
Q

How is norovirus diagnosed?

A

PCR

Infection (13 decks)

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