Lecture 5: Diarrhea and Anaerobes

Question 1

Infectious Diarrhea: Management

Answer 1

General guidelines

– Rehydration

– Alteration of diet.
• Hydration via oral route with water, salt and sugarsolution

– 1⁄2 teaspoon salt, 1⁄2 teaspoon baking soda, 4 tablespoons sugar to 1 liter of water.

• Alteration of diet
– Avoid milk products after viral gastroenteritis

– Low roughage after enteric fever

Patients with acute diarrhea with the following symptoms may require non pseudomonal quinolone for 3 – 5 days

– Fever, bloody diarrhea, fecal leukocytes

– Diarrhea for more than a week

– More than 8 stools a day

– Dehydration

– Need to admit to hospital

– Immunocompromised host

Antimotility agents for watery diarrhea without fever. Never use for C. difficile or dysentery. (toxic megacolon)

Do not use antibiotics for E. coli O157-H7 disease.

Question 2

Anaerobic Infections: Clostridium perfringens

Answer 2

Etiopath

• Alpha toxin has sphyngomyelinase and phospholipase C activity. (a cytolysin)
• Introduction of spores into deep tissue at time of injury
• If devitalized, anaerobic environment promotes growth of organism and myonecrosis or gas gangrene occurs within 24 to 36 hours
• White cells are absent from infected tissue
• Shock is secondary to effects of alpha and theta toxins
  
  • Decreased cardiac output- alpha toxin
  • Decreased systemic vascular resistance- theta toxin

Therapy: penicillin + clindamycin + surgery

Question 3

Anaerobic infections: C. botulinum

Answer 3

Epidemiology

• 72% of cases occur in newborns, 25% are food borne, 3% wound related
• 110 cases / year in USA
• May be associated with IVDU and cocaine inhalation

Sx

Bilateral cranial neuropathies with descending symmetrical motor weakness. No fever, sensory deficits, loss of consciousness, tachycardia or hypotension

Rx

• Supportive care including ventilation
• Antitoxin administration
• Hospitalization required for 1 to 3 months