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infection > infectious diarrhoea > Flashcards

infectious diarrhoea Flashcards

1
Q

what are the causes of gastro-enteritis ?

A

contamination of foodstuffs
poor storage of produce
travel related infection
person to person spread

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2
Q

what is the most common cause of GI infection ?

A

viruses

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3
Q

what are the three most common bacterium which cause food poisoning ?

A

campylobacter
salmonella
E.coli

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4
Q

what are defences against enteric infections ?

A

hygiene
stomach acidity
normal gut flora
immunity

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5
Q

what are the different clinical features of diarrhoeal illness and what causes them ?

A

non-inflammatory/secretory - cholera
inflammatory - shigella dysentry
mixed picture - C. difficile

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6
Q

what are the features of non-inflammatory diarrhoea ?

A

secretory toxin-mediated- cholera increases cAMP levels and Cl secretion, enterotoxin E.coli same
frequent watery stools with little abdominal pain
rehydration is mainstay

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7
Q

what are the features of inflammatory diarrhoea ?

A

pain and fever
inflammatory toxin damage and mucosal destruction
bacterial infection/amoebic dysentry
Abx may be appropriate but rehydration is often enough

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8
Q

what is important when assessing the patient with diarrhoea ?

A

symptoms and duration - >2/52 unlikely to be infective GE
risk of food poisoning-dietary, contact, travel
assess hydration- postural BP, skin turgor, pulse
features of inflammation- fever, raised WCC

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9
Q

what happens to electrolyte balance in diarrhoea ?

A

hyponatraemia

hypokalaemia

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10
Q

what investigations should be done for diarrhoea ?

A 
stool culture + Ag testing
blood culture
renal function
blood count - neutrophilic, haemolysis
abdo x-ray/CT
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11
Q

what are the differential diagnosis for diarrhoea ?

A

inflammatory bowel disease
spurious diarrhoea - secondary to constipation
carcinoma
sepsis

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12
Q

what signs indicate diarrhoea may be caused by sepsis ?

A

lack of abdominal pain/tendernes

no blood/mucus in stools

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13
Q

how do you treat gastro-enteritis ?

A

rehydration IV/Oral

salt/sugar solution

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14
Q

what are features of campylobacter GE ?

A

up to 7 days incubation so dietary history unreliable
stools negative within 6 weeks
abdo pain severe
post infection sequelae - Guillain barre, reactive arthritis

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15
Q

what are the two most common species of infective campylobacter ?

A

C. jejuni

C. coli

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16
Q

what are features of salmonella GE ?

A

symptom onset <48 hrs after exposure
diarrhoea <10 days
prolonged carriage of pathogen associated with gallstones
post infectious irritable bowel common

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17
Q

what are the two most common types of salmonella species ?

A

S. enteritidis

S. typhimurium

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18
Q

what is salmonella screened as in a lab ?

A

lactose non-fermenters

antigen O,H

19
Q

how is E.coli spread ?

A

contaminated meat

person to person

20
Q

what are features of E.coli GE ?

A

frequent bloody stools

21
Q

what toxin does E.coli release ?

A

shiga toxin

22
Q

what can the E.coli toxin cause if leaked into blood ?

A

haemolytic-uraemia syndorme

23
Q

how is haemolytic uraemia syndrome characterised ?

A

renal failure
haemolytic anaemia
thrombocytopenia

24
Q

how is haemolytic uraemic syndrome treated ?

A

supportive

25
Q

what is the pathophysiology of HUS ?

A

toxin stimulates platelet activation

micro-angiopathy results

26
Q

what are the four species of shigella ?

A

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

27
Q

what are causes of occasional food poisoning ?

A

Staph Aureus
Bacillus cereus - re-fried rice
Clostridium perfringens - undercooked meat

28
Q

when should Abx be used for gastroenteritis ?

A

immunocompromised
severe sepsis/ invasive infection
chronic illness - malignancy

29
Q

what toxins does c.dif produce ?

A

enterotoxin A

cytotoxin B

30
Q

how is c. Dif infection treated ?

A 
metronidazole
stop precipitating antibiotic
oral vancomycin
fidaxomicin
stool transplants
surgery
31
Q

what are the 4C antibiotics which cause c.dif infection ?

A

cephalosporins
co-amoxiclav
clindamycin
ciprofloxacin

32
Q

how are parasites diagnosed in stool ?

A

send stool with parasites, cysts, ova

33
Q

what is the most common type of protozoa which causes diarrhoea ?

A

Giardia duodenalis

34
Q

what are features of protozoa diarrhoea ?

A

diarrhoea
gas
malabsorption
failure to thrive

35
Q

how are protozoa transmitted ?

A

direct contact with cattle/cats/dogs/people

contaminated food/water

36
Q

how are protozoa diagnosed ?

A

cysts seen on stool microscopy

trophozoites - duodenal biopsy tightly bound to villi

37
Q

how is protozoa treated ?

A

metronidazole

38
Q

how is cryptosporidium parvum diagnosed ?

A

oocytes seen on microscopy

39
Q

how is entamoeba histolytica diagnosed ?

A

trophozoites in symptomatic patients

cysts seen in asymptomatic patients

40
Q

what is a complication of entamoeba histolytica infection

A

amoebic liver abscess

41
Q

what viruses causes diarrhoea ?

A

rotavirus
norovirus
adenovirus

42
Q

what is the most common viral cause of diarrhoea in children under 5

A

rotavirus

43
Q

what virus is the most common cause of diarrhoea outbreaks ?

A

norovirus

44
Q

how is norovirus diagnosed ?

A

PCR

infection (2 decks)

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