Inflammatory acute diarrhea Flashcards
Mainly asymptomatic, immunocompetent:
Acute - fever, malaise, myalgias, arthralgias, splenomegaly
Rash is common (esp with amoxicillin!)
Diarrhea, weight loss, abdominal pain in immunosuppressed/AIDS
~7-8 wks
No pharyngitis symptoms (differentiate from mono)
CMV
Older age, lower socioeconomic status, employed in child-care, many sexual partners, hx of STIs
HHV 5 through sexual contact, breastfeeding, blood products
“C in TORCH”
MC congenital infection in NBs
CMV
how do you treat CMV
ganciclovir
2-4 week incubation period
Frequently asymptomatic
Intestinal ambeiasis = dystenary
Bloody diarrhea, abdominal pain, colitis
Fever
Can progress to necrotizing colitis
Intestinal perforation
Mucosal sloughing
>40% mortality rate
SEVERE: extraintestinal amebiasis and abscesses – LIVER is MCL, hepatomegaly, RUQ pain, weight loss, high fever
amebiasis
tropical/subtropical → crowding, poor sanitation, poor nutrition
Transmitted through ingestion of cysts: fecal-oral, person to person, flies, human excrement
E. histolytica (intestinal destruction), E dispar, E moshkovskii
Can progress to colitis and dysentery
amebiasis
Intestinal amebiasis:
Stool microscopy
Stool antigen testing
Stool PCR
Hepatic abscesses:
US, CT, MRI (mostly single)
Anti-amebic antibodies in serum
Elevated liver enzymes
Prevent w/ good sanitation, clean water, adequate cooking, handwashing, protection of food from flies
entamoeba
how do you treat amebiasis
Metronidazole or tinidazole + luminal agent, like:
Diloxanide
Iodoquinol
Paromomycin
Alternate = tetracycline + chloroquine
Replace fluid and electrolytes
Surgical management of acute complications, including needle aspiration of large hepatic abscesses
Toxic megacolon and pancolitis require emergency colectomy
Watery diarrhea → bloody, abdominal cramping, vomiting, fever low grade (or absent)
Daycare centers, petting zoos
Children
Elderly
Cytotoxin-producing bacteria → shiga-toxin producing from contaminated meat (undercooked ground beef), unpasteurized milk/apple cider vinegar, contaminated water
Enterohemorrhagic e.coli
DO NOT USE — with EHEC
antibiotics – can cause HUS
Incubation 2-48 hours
Similar to cholera: abrupt onset of watery diarrhea, abdominal cramps, N/V
Underlying liver disease
Immunocompromised
Cytotoxin-producing bacteria associated with raw seafood/shellfish in the Gulf of Mexico
Vibrio parahaemolyticus
Mild-moderate greenish, foul-smelling watery diarrhea
3-15 stools/day with lower abdominal cramps
Older, debilitated, immunocompromised, receiving multiple antibiotics, prolonged antibiotic therapy, tube feedings, PPIs, chemo, IBD
Almost always from c difficile
– fecal-oral transmission
MC: ampicillin, clindamycin, 3rd gen cephs, fluoroquinolones
c diff
How do you treat c dif
Contact precautions
Discontinue agent
Fidaxomicin or vancomycin
Fulminant disease = oral vancomycin + IV metronidazole + surgical consult
Abrupt onset of explosive diarrhea, lower abdominal cramps, tenesmus (rectal urge); stool = blood and mucus
Systemic = fever, chills, anorexia, malaise, headache, lethargy
Day care
Travel
Fecal-oral, water, person-person spread
Tender abdomen
Sigmoidoscopy = inflamed, engorged mucosa with punctate and large areas of ulceration
Stool culture = many leukocytes + red cells
shigella
With severe shigella, treat with
fluoroquinolones
1-7 days post infection
Fever, muscle pain, malaise, headache → crampy abdominal pain, diarrhea (water, bad smelling, bloody)
C jejuni or C coli; dairy and undercooked poultry; raw milk → toxic inflammation → toxic megacolon
campylobacter jejuni
Incubation 1-3 days
Gastroenteritis: gradual or abrupt onset of diarrhea, low grade fever, potentially bloody stool or “pea soup”, abdominal cramping
Typhoid fever: prolonged incubation, headache, constipation, pharyngitis, cough → crampy abdominal pain, diarrhea (PEA SOUP), intractable fever, bradycardia
Summer months
Typhoid = Latin america, Asia, India travel
Poultry products (dairy, meat, eggs), exotic pets (reptiles!), w/ fecal-oral transmission
Rose spots in 2nd week
Hepatosplenomegaly
Fever with relative bradycardia
salmonella
Pregnancy - last trimester, mild febrile illness, 20% miscarriage rate; surviving = neonatal listeriosis
Granulomatosis infantiseptica -neonatal infection, disseminated abscesses, granulomas, high mortality
Bacteremia - w or w/o sepsis, neonates or immunocomp, febrile illness with no recognized source
Meningitis - infants <2, older adults, CSF = lymphocytic pleocytosis, protein/glucose
Focal - adenitis, brain abscess, endocarditis, arthritis
commonly associated from eating contaminated food (dairy) - unpasteurized dairy products, hot dogs, deli meats, cantaloupes, ricotta cheese
listeria
listeria is treated with
IV ampicillin
how do you prevent listeria
avoid unpasteurized milk, raw cheese, smoked seafoods, cold cuts, hot dogs, meat spreads, THOROUGHLY cook everything, wash veggies
Incubation of 24-48 hours, fever, abdominal pain mimicking appendicitis, diarrhea
Reactive arthritis, erythema nodosum
infants
Mucosal invasion bacteria from undercooked pork, contaminated water, unpasteurized milk, tofu
common in infants
Yersinia enterocolitica
