Infectious Diarrhoea Flashcards
What is the difference between diarrhoea, gastro-enteritis and dysentery?
diarrhoea: fluidity and frequency (subjective)
gastro-enteritis: three or more loose stools/day + accompanying features (objective)
dysentery: large bowel inflammation + blood stools (obvious)
What are the 7 types of stool on the Bristol stool chart?
What are some causes of gastro-enteritis?
- contamination of foods
- poor storage of produce: bacterial proliferation at room temp
- travel related infections: eg salmonella
- person to person spread: eg norovirus
Are viruses or bacteria the most common cause of gastro-enteritis?
Viruses
Which bacteria is the commonest bacterial pathogen for gastro-enteritis?
Campylobacter
What bacteria causes the most hospital admissions due to gastro-enteritis?
Salmonella
What are some defences against enteric infection?
- Hygiene
- Stomach acidity
- Normal gut flora
- Immunity
What are the 3 classes of clinical features of diarrhoeal illness?
- non-inflammatory/secretory
- inflammatory
- mixed
How do non-inflammatory/secretory illnesses cause diarrhoea?
secretory toxin-mediated
- cholera increases cAMP levels and Cl secretion
What is an example of bacteria that causes non-inflammatory/secretory illness and diarrhoea?
- enterotoxigenic E.coli (travellers diarrhoea)
- cholera
What is the main therapy for a non-inflammatory/secretory illness causing diarrhoea?
- Rehydration mainstay of therapy
What is an example of a bacteria causing inflammatory diarrhoeal illness?
Shigella dysentery
Describe how inflammatory illness causes diarrhoea?
- inflammatory toxin damage and mucosal destruction causing pain and fever
- bacterial infection/amoebic dysentery
What is the treatment for inflammatory illnesses causing diarrhoea?
- Antimicrobials but rehydration alone is often sufficient treatment
Which of non-inflammatory/secretory or inflammatory illness is more associated with pain?
Non-inflammatory - frequent watery stools with little abdominal pain
Inflammatory - pain and fever
What is an example of bacteria causing diarrhoea by both non-inflammatory and inflammatory mechanisms?
C. Difficile
Describe the mechanism of diarrhoea in cholera?
- Increased cAMP results in loss of Cl from cells along with Na and K
- Osmotic effect leads to massive loss of water from gut
In what kind of diarrhoea can fluid and electrolyte loss be severe?
Fluid and electrolyte loss can be severe with secretory diarrhoea:
- Hyponatraemia due to sodium loss
- Hypokalaemia due to K loss
When assessing a patient with diarrhoea what should be explored?
- Symptoms and duration
- Risk of food poisoning
- Dietary, contact, travel history
- Assess hydration
- Postural BP, skin turgor, pulse
- Features of inflammation
- Fever, raised WCC
What are signs of poor hydration?
What investigations should be done for diarrhoea?
- Stool culture with or without molecular or Ag testing
- Blood culture
- Renal function
- Blood count
- Neutrophilia, haemolysis
- Abdominal x-ray/CT if abdomen distended or tender
What is the common differential diagnosis for infectious diarrhoea?
- Inflammatory bowel disease
- Spurious diarrhoea
- Secondary to constipation
- Carcinoma
What are indicators that the diarrhoea and fever is not due to gastro-enteritis?
Diarrhoea and fever can occur with sepsis outside of the gut:
- Lack of abdominal pain goes against gastroenteritis
- No blood/mucus in stools
What is the treatment of gastro-enteritis?
Rehydration:
- Oral rehydration with salt/sugar solution
- IV saline
What is done to identify causative organism of infectious diarrhoea?
Routine bacterial culture is done to identify causative organism, but is difficult midst complex normal flora:
- Takes 3 days to complete all tests
- Selective and enrichment methods of culture necessary
- Molecular detection
- Antigen detection
What two species of coampylobacter cause the most infections?
- C. Jejuni (90%)
- C. Coli (9%)
Where is campylobacter found?
Found in chickens, contaminated milk, puppies
Does campylobacter gastroenteritis usually occur in isolated cases or outbreaks?
Isolated cases