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Infectious Disease > Infectious Diarrhoea > Flashcards

Infectious Diarrhoea Flashcards

1
Q

What is diarrhoea? What is gastro-enteritis?

A

Diarrhoea - subjective, describes increase fluidity and frequency

Gastro-enteritis - objective, 3 or more loose stools per day + accompanying features (pain / fever / vomiting etc.)

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2
Q

What is Dysentery?

A
  • Large bowel inflammation

- Blood / mucus in faeces, abdominal cramps, severe diarrhoea

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3
Q

On the stool chart, patients with food poisoning / bacterial gastroenteritis tend to have a score of?

A

6 or 7

+ additional features such as blood / mucus in stool or abdominal cramping

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4
Q

What are the most common causes of gastroenteritis?

A
  1. Viral gastroenteritis (norovirus)
  2. Campylobacter (commonest pathogen)
  3. Salmonella (only 1% of cases but causes most hospital admissions)
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5
Q

What are the three types of diarrhoeal illness & an example of each?

A
  1. Non-inflammatory - cholera
  2. Inflammatory - shigella dysentery
  3. Mixed Picture - C. Difficile
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6
Q

How does non-inflammatory diarrhoea tend to present?

A
  • Frequent watery stools with little abdominal pain

- Minimal, if any, systemic upset / fevers

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7
Q

What is the general mechanism for non-inflammatory diarrhoea pathogens?

A

Secretory toxin mediated

  • Toxin causes excess secretion of water from gut
  • Eg. cholera causes increase in cAMP which results in increased Cl secretion, followed by Na / K & water
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8
Q

How does inflammatory diarrhoea tend to present?

A
  • Frequent watery stools + abdominal pain + fever
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9
Q

How is non-inflammatory diarrhoea treated? How is inflammatory diarrhoea treated?

A

Non-inflammatory - rehydration

Inflammatory: rehydration +/- antimicrobials (rehydration usually sufficient)

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10
Q

What are some important questions when taking a history for suspected gastroenteritis?

A
  • Duration of sickness (if >2 weeks gastroenteritis unlikely)
  • Travel history / risks of food poisoning
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11
Q

Clinical examination for suspected gastroenteritis?

A
  • Assess hydration: postural BP / skin turgor / pulse
  • Features of inflammation (fever)
  • Infants: sunken eyes, dry mouth, sunken fontanelle
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12
Q

Investigations for suspected gastroenteritis?

A
  • FBC (electrolytes / neutrophilia / haemolysis)
  • Stool culture / blood culture
  • Renal function
  • Abdominal X-Ray / CT if abdomen distended
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13
Q

DDx for diarrhoea?

A
  • Inflammatory bowel disease
  • Spurious diarrhoea (secondary to constipation - old people)
  • Carcinoma
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14
Q

How do you rehydrate a person with gastroenteritis?

A
  • Salt/Sugar solution
  • glc. & Na symported in intestine, increasing levels of them increases absorbtion, and water follows electrolytes in
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15
Q

What are some characteristics of Campylobacter Gastroenteritis?

A
  • Up to 7 days incubation period
  • Can present with severe abdominal pain
  • Not usually invasive, if seen in serum consider underlying pathology
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16
Q

What are some characteristics of Salmonella Gastroenteritis?

A
  • Symptom onset usually within 48hrs of exposure
  • Diarrhoea usually lasts <10 days
  • Post infectious irritable bowel is common
17
Q

What are some characteristics of E. Coli O157 Gastroenteritis?

A
  • Characterized by frequent bloody stools
  • The E. Coli tends to remain in the gut, but its toxin (shiga toxin) invades the blood
  • Can cause haemolytic-uraemic syndrome
18
Q

What is haemolytic uraemic syndrome?

A
  • Haemolytic anaemia, renal failure & thrombocytopenia (low platelets)
  • Caused by toxins stimulating platelet activation within the body (breaks down RBCs as they pass through)
  • Treatment tends to be supportive (dialysis etc.)
19
Q

When are antibiotics indicated in gastroenteritis?

A
  • Immunocompromised patients
  • Severe sepsis / septicaemia
  • Patients with chronic illness (eg. malignancy)
20
Q

What are the most common strains of salmonella causing gastroenteritis?

A
  • Salmonella enteritidis

- Salmonella typhimurium

21
Q

How can C. Difficile present? Why is this?

A
  • Severity ranges from mild diarrhoea to severe colitis (mixed picture between inflammatory & non-inflammatory)
  • Because C. Diff produces 2 different toxins: enterotoxin & cytotoxin
22
Q

Treatment of C. Diff infection?

A

Metronidazole

oral vancomycin / Fidaxomicin

Stool transplants

surgery may be required

23
Q

How is infection with parasites (protozoa and helminths) diagnosed?

A

Diagnosis generally by microscopy

24
Q

Most common protozoal infection in the UK? Symptoms? Treatment?

A
  • Giardia lamblia
  • Abdominal cramps, bloating, nausea and bouts of watery diarrhoea, malabsorption and failure to thrive
  • Metronidazole to treat
25
Q

What are the most common causes of viral diarrhoea?

A
  1. Norovirus
    - Rotavirus (children under 5yrs)
    - Adenovirus (only certain strains)
26
Q

How infectious is norovirus? What measures are commonly taken when detected? How is it detected?

A
  • Very infectious, isolation & ward closures common when detected
  • Diagnosed by PCR
27
Q

Most common bacterial, parasitic and viral causes of diarrhoea?

A
  • Bacterial gastroenteritis: Campylobacter, Salmonella, E.coli
  • Parasitic diarrhoea: Giardia, Cryptosporidium, Entamoeba histolytica
  • Viral diarrhoea: rotavirus, adenovirus, norovirus

Infectious Disease (13 decks)

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