Inflammatory diarrhea Flashcards
Stool characteristics of inflammatory diarrhea
Copious, watery diarrhea without blood or WBCs. No tissue invasion
Gram negative non-motile rod of the enterobacteriaceae family. Non-lactose and non-sucrose fermenter.
Salmonella
Allows salmonella to be bile salt tolerant
Produces H2S
Non-typhoidal strains of Salmonella enterica
Enteritidis
Typhimurium
Typhoidal strains of Salmonella enterica
Typhi
Paratyphi
Virulence factors of Salmonella
Pili
Vi capsular antigen
Type III secretion system
LPS
Enterotoxin
Affect of type III secretion system of Salmonella
Induces membrane ruffling in host cells
Salmonella selectively attach to these specialized epithelial cells
M cells of Peyer patches
Incubation period of non-typhoidal salmonellosis
6-48 hrs
Complications of non-typhoidal salmonellosis
Osteomyelitis in sickle cell disease
Septicemia in immunosuppressed
Endocarditis
Arthritis
Treatment of septicemia from non-typhoidal salmonellosis
Fluoroquinolones
Cephalosporins
Can lead to carrier state of typhoidal salmonellosis
Chronic colonization of gallbladder
Pt presents with a gradual onset of HA, lethargy, fever, abdominal pain, interchanging diarrhea and constipation lasting for several weeks. They have hepatosplenomegaly and rose spots on exam.
Typhoidal salmonellosis
Complications of typhoidal salmonellosis
Intestinal hemorrhage
Ileal perforation
When is serology positive in typhoidal salmonellosis?
Week 2
When is stool culture positive in typhoidal salmonellosis?
Week 3
When is urine culture positive in typhoidal salmonellosis?
Week 4
Black colonies on Hektoen Enteric agar and NLF colonies on MacConkey’s agar.
Salmonella
Treatment for typhoidal salmonellosis
Fluoroquinolones
Third gen cephalosporins
Gram negative curved motile rods with polar flagella. Catalase and oxidase positive.
Campylobacter
Most common cause of community acquired inflammatory enteritis
Campylobacter
Allows for low infectious dose of campylobacter
Acid tolerant
Adhesins of campylobacter
CadF
CapA
JlpA
FlpA
Intrinsic resistance to these antibiotics of Campylobacter
Vancomycin
Trimethoprim
Polymyxin B
Virulence factors of Campylobacter
LOS endotoxin
CPS
Adhesins
CDT
Cytotoxin
Heat labile cholera-like enterotoxin
Incubation period of Campylobacter
1-7 days
Antigenic cross-reactivity between LOS of C jejuni and peripheral nerve gangliosides can result in this
Guillain-Barre syndrome
Clinical manifestations seen in Campylobacter infection
Acute colitis
Abdominal pain mimicking acute appendicitis
Chronic enteric infections
Stool culture on CAMPY or Skirrow medium at 42 C in a microaerophilic atmosphere for diagnosis
Campylobacter
Treatment for severe Campylobacter infections
Macrolides
Fluoroquinolones
Gram negative coccobacilli with bipolar staining. Psychrophilic. Motile between 25 C and 37 C.
Yersinia enterocolitica
Treatment for Yersinia enterocolitica
Fluoroquinolones
TMP-SMZ
How to distinguish V cholerae from V parahaemolyticus?
V parahaemolyticus is halophilic and can grow in 8% NaCL
Causes diarrheal disease associated with eating contaminated undercooked/raw seafood. With HA and low-grade fever.
V parahaemolyticus
Enterotoxin of V parahaemolyticus that induces chloride ion secretion
Kanagawa hemolysin
Treatment for severe V parahaemolyticus infection
Doxycycline
Fluoroquinolones
Causal organism of hemorrhagic colitis
Shiga-toxin producing E coli (STEC)
Stx1 and Stx2 disrupt protein synthesis causing A/E lesions with destruction of intestinal microvilli
Hemorrhagic colitis (STEC)
Possible complications of STEC infection
Hemolytic uremic syndrome
Diagnosed by screening for O157:H7 with Sorbitol-MacConkey agar and confirmed with serotyping.
STEC
Treatment for hemorrhagic colitis
Avoid antibiotics –> can stimulate Stx and cause hemolytic uremic syndrome
Supportive care
