MI: GI infections Flashcards

1
Q

List some reportable GI infections

A
  • Camplybacter
  • Salmonella
  • Shigella
  • Escherichia coli O157
  • Listeria
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2
Q

What are the main characteristics of secretory diarrhoea? What are some causes?

A
  • No fever/low grade fever
  • No inflammatory cells in stool
  • Causes: Vibrio Cholera, ETEC
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3
Q

What are the main characteristics of inflammatory diarrhoea? What are some causes?

A
  • Fever
  • Inflammatory cells present in stool (neutrophils)
  • Causes: Campylobacter jejuni, Shigella, non-typhiodal Salmonella, EIEC

Also known as exudative diarrhoea

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4
Q

List some examples of severe GI infections that produce a fever with little stool changes.

A

Also known as enteric fever

  • Salmonella typhi
  • Enteropathogenic Yersinia
  • Brucella

White blood cells are present in stool (mononuclear cells)

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5
Q

Describe the mechanism by which Vibrio cholerae causes secretory diarrhoea.

A
  • The cholera toxin has subunits A and B which stimulate adenylate cyclase.
  • This leads to the production of cAMP which opens chloride channels on the membranes of enterocytes.
  • Chloride efflux into the lumen is accompanied by water and electrolyte loss.
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6
Q

What are superantigens?

A
  • Toxins that bind to TCR and MHC outside the peptide binding region
  • This leads to non-specific activation and large-scale polyclonal expansion of T cells with massive cytokine production
  • Results in systemic toxicity and suppression of adaptive immune response
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7
Q

How does the host immune response determine in inflammatory respone to enteropathic bacteria?

A
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8
Q

What type of organism is Staphylococcus aureus?

A
  • Gram-positive coccus
  • Catalase and coagulase positive
  • Appears in clusters
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9
Q

What type of toxin is produced by Staphylococcus aureus?

A

Enterotoxin - this is an exotoxin that can act as a superantigen in the GI tract triggering the release of IL1 and IL2

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10
Q

How is Staphylococcus aureus spread and what kind of GI symptoms can it cause?

A
  • Spread by skin lesions on food handlers
  • Causes prominent nausea and vomiting (occasionally watery diarrhoea)
  • Self-limiting (resolution within 24 hours) so does not require treatment
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11
Q

What type of organisms is Bacillus cereus?
Associated food?

A

Gram-positive rods that are spore-forming

Spores germinate in reheated rice

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12
Q

What type of toxins does B. cereus produce?

A
  • Heat-stable emetic toxin
  • Heat-labile diarrhoeal toxin
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13
Q

What type of GI symptoms does B. cereus cause?

A

Diarrhoeal type - watery, non-bloody diarrhoea; abdominal cramping

Emetic type - nausea and vomiting (sometime diarrhoea as well)

NOTE: it can cause bacteraemia and cerebral abscesses in vulnerable populations

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14
Q

Name three types of Clostridium infection

A
  • Clostridium botulinum
  • Clostridium perfringens
  • Clostridium difficile
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15
Q

What kind of infection does Clostridium botulinum cause?

Associated foods?

Treatment?

A

Causes botulism - ptosis, double vision, dysphagia, progessive muscle weakness and paralysis

  • From canned food
  • Causes disease due to preformed toxin which blocks acetylcholine release at peripheral nerve synapses resulting in paralysis
  • Treated with antitoxin
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16
Q

What kind of infection does Clostridium perfringens cause?

A

Causes food poisoning - watery diarrhoea, cramps, but NO vomiting that lasts 24 hours

  • From undercooking and poor storage of meat
  • Part of normal colonic flora, but NOT small bowel
  • Creates enterotoxic superantigen affects small bowel
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17
Q

What kind of infection does C. difficile cause?

A

Pseudomembranous colitis

  • Hospital-acquired infection related to antibiotic use
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18
Q

Which antibiotics are most commonly implicated in C. difficile colitis?

A
  • Cephalosporins
  • Clindamycin
  • Ciprofloxacin
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19
Q

How is C. difficile colitis treated?

A
  • Metronidazole, vancomycin
  • Stop the offending antibiotic
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20
Q

What type of organism is Listeria monocytogenes?

A
  • Gram positive, rod-shaped, facultative anaerobe
  • Beta-haemolytic, aesculin-positive with tumbling motility
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21
Q

What is the source of Listeria?

A

Grows are 4 degrees so refrigerated foods (cold enhancement)

  • Unpasteurised dairy
  • Vegetables
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22
Q

What GI symptoms does Listeria tend to cause? Which patients groups are particularly susceptible?

A
  • Fever, watery diarrhoea, cramps, headache and NO vomiting
  • Neonates, immunocompromised
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23
Q

How is Listeria infection treated?

A

Ampicillin

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24
Q

What type of organisms are Enterobacteriaceae and name some examples?

A
  • Facultative anaerobes
  • Lactose fermenters
  • Oxidase-negative
  • Escherichia coli, Salmonella, Shigella, Klebsiella
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25
Name and describe the different types of *E. coli* infection.
* **ETEC** - toxigenic, main cause of travellers' diarrhoea * **EPEC** - pathogenic, infantile diarrhoea * **EIEC** - invasive, dysentry * **EHEC** - haemorrhagic, caused by *E. coli* 0157:H7 ## Footnote Avoid antibiotic treatment
26
Where does *E. coli* act?
Jejunum, ileum but NOT colon
27
Which toxin causes haemolytic uraemic syndrome?
EHEC shiga-like verocytotoxin
28
What type of bacteria are *Salmonellae?*
- Gram-negatives, Non-lactose fermenting, - Produce hydrogen suphide (form black colonies) - Grows on TSI agar, XLD agar and selenite F broth
29
Which antigens are found on *Salmonellae?*
* LPS **O antigen** (groups A-I) * Flagellar **H antigen** * Capular **Vi antigen** (virulence, antiphagocytic) ## Footnote NOTE: differences in these antigens help identify the serotypes of *Salmonellae*
30
List 2 main species of *Salmonella*.
* *Salmonella typhi* * *Salmonella enterica*
31
What are 2 important serotypes of *S. enterica*?
- *Salmonella enterica* serotype Enteritidis - *Salmonella enterica* serotype Typhimurium
32
How is *Salmonella* Enteritidis transmitted?
Via infected poultry, eggs, meat
33
Describe the presentation of *Salmonella* Enteritidis.
Causes enterocolitis - self-limiting diarrhoea that is non-bloody * Bacteraemia is rare * Usually **no treatment required**
34
How is *Salmonella typhi* transmitted?
* Transmitted only by humans (faeco-oral) * Multiplies in Peyer's patches and spreads via the endoreticular system
35
Describe the presentation of *Salmonella typhi.*
Causes typhoid fever with constipation (rose coloured spots)
36
Which subset of patients are at increased risk of *Salmonella* bacteraemia?
Sickle cell patients
37
How is *Salmonella typhi* treated?
Ceftriaxone
38
What are some key microbiological features of *Shigella?* (stains etc)
- Gram negative - Non-lactose fermenter - Does NOT produce hydrogen suphide - Non-motile
39
Which antigens are seen on *Shigella?*
LPS O antigens ##FOOTNOTE Polysaccharide (groups A-D) used to identify species
40
List some types of *Shigella.*
* *Shigella sonnei* * ***Shigella dysenteriae*** * *Shigella flexneri* (MSM)
41
What is the most effective bacterial enteric pathogen and why?
*Shigella* - it has the lowest infective dose (50) ## Footnote NOTE: Shigella has no animal reservoir and no carriers state
42
How does *Shigella* infection manifest? How do you treat it?
**Dysentry** - Severe diarrhoea with blood and mucus in the faeces - Invades the cells of the distal ileum and colon - Produces shiga toxin **Avoid antibiotics when treating, however use ciprofloxacin if required**
43
What are the microbiological features of *Vibrio Cholerae?*
- Gram-negative - Comma-shaped - Late lactose-fermenters - **Oxidase-positive**
44
What are the different groups of *Vibrio cholerae?*
* O1 - causes epidemics * Non-O1 - sporadic, non-pathogens
45
How is *Vibrio cholerae* transmitted?
Contamination of water and food from human faeces
46
What type of GI disturbance does *Vibrio cholerae* cause and how do you treat it?
- Produces massive watery (secretory) diarrhoea without inflammatory cells - Treat by replacing the water and electrolytes lost
47
Name and describe the key features of other types of *Vibrio.* How is it treated?
***Vibrio parahaemolyticus:*** * Caused by ingestion of raw/undercooked seafood * Causes self-limiting diarrhoea (3 days) * Grows on salty agar ***Vibrio vulnificus:*** * Causes cellulitis in shellfish handlers * Can cause fatal septicaemia with diarrhoea and vomiting in HIV patients Treat both with **doxycycline**
48
What are the main microbiological features of *Campylobacter?*
* Gram negative * Comma-shaped * Microaerobphilic * Oxidase-positive * Motile
49
How is *Campylobacter* transmitted?
Transmitted via ingestion of **food and water contaminated with animal faeces**
50
Describe the presentation of *Campylobacter jejuni* infection.
- Watery, foul-smelling diarrhoea, bloody stools, fever and severe abdominal pain
51
How is *Campylobacter* infection treated?
Only treated if immunocompromised - **Erythromycin or ciprofloxacin** if presenting within first 4-5 days
52
What are some complications of *Campylobacter* infection?
Guillian-Barre syndrome Reactive arthritis
53
Which other bacterial organisms can cause GI disease?
*Yersinia enterocolitica* - Non-lactose fermenting - Transmitted via food contaminated with faeces of domestic animals - Causes enterocolitis and mesenteric adenitis - Also associated with reactive arthritis *Mycobacteria* (*M. Tuberulosis, Avium, Intracellulare*)
54
What are the key characteristics of *Entamoeba histolytica?*
* Motile trophozoite in diarrhoeal illness * Non-motile cyst in non-diarrhoeal illness * Killed by boiling, removed via water filters * Contains four nuclei * No animal reservoir
55
Describe the pathophysiology of diarrhoeal illness caused by *Entamoeba histolytica.*
Ingestion of cysts → trophozoites move into the ileum → colonise the colon → causes **flask-shaped ulcers**
56
Describe the presentation of GI infection by *Entamoeba histolytica.*
* Dysentry * Flatulence * Tenesmus * Liver abscess ## Footnote Chronic infection can cause weightloss +/- diarrhoea
57
How is *Entamoeba histolytica* infection diagnosed and treated?
* Diagnosis: stool microscopy (wet-mount, iodine and trichrome), serology of invasive disease * Treatment: **metronidazole** + paromomycin
58
What are the key microbiological features of *Giardia lamblia?*
* **Pear-shaped trophozoites** * Two nuclei * Four flagellae and a suction disc
59
Outline the pathophysiology of GI disease caused by *Giardia.*
* Transmitted by ingestion of cyst from **faecally contaminated water** * Excystation in the **duodenum** leads to trophozoite attachment * Results in malabsorption of protein and fat
60
How does *Giarda* infection present?
- Foul-smelling non-bloody diarrhoea, - Cramps, flatulence, - NO fever
61
How is *Giardia* infection diagnosed and treated?
* Stool microscopy * ELISA * String test * Treatment: **metronidazole**
62
What are the main features of *Cryptosporidium parvum?* What stain is used?
* **Protozoa** that causes severe diarrhoea in the **immunocompromised** * **Oocysts** can be seen in the stool using modified **Kinyoung** acid fast stain * Treated by boosting the immune system
63
What is the predominant strain of norovirus?
GII4
64
What is rotavirus and what does it cause?
* dsDNA virus * Replicates in the mucosa of the small intestine * Causes secretory diarrhoea with no inflammation ## Footnote NOTE: exposure to natural infection twice will confer lifelong immunity
65
List some other viruses that can cause diarrhoeal illnesses.
* **Adenovirus** (types 40 and 41 can cause non-bloody diarrhoea in <2 year olds) - diagnosed via PCR or stool antigen detection * **Poliovirus** * **Enterovirus** (e.g. coxaskie, echovirus) * **Hepatitis A** ## Footnote Transmitted via faeco-oral route
66
Which causes of diarrhoeal illness have available vaccines?
* *Cholera* (serogroup O1) * *Campylobacter* * ETEC * *Salmonella typhi* * Rotavirus - rotarix (live, monovalent), rotateq (pentavalent), rotashield (used if risk of intussusception)
67
Who is responsible for collecting reports of diarrhoeal illness and identifying outbreaks?
Health Protection Unit (HPU)