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Study Notes - Gastroenterology > Microbiology 4 (Dr Orange) > Flashcards

Microbiology 4 (Dr Orange) Flashcards

1
Q

What is the incubation period?

A

the time between contracting the infection (i.e. swallowing the organsim) and the first clinical symtpoms/ signs of infection

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2
Q

What avoidable circumstances are most infections in the community related to?

A

Cross-contamination of work surfaces/ utensils
Undercooking (insufficient heat to kill off pathogens), linked to inadequate defrosting of frozen food
Improper storage of food (inadequate refrigeration)
Poor reheating of food

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3
Q

What are the purpose of local microbiology laboratories in terms of when they find a GI infection? (2)

A

All GI infections reported promptly to local Health Protection Team
All isolates sent to Scottish Reference Lab

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4
Q

Where are all isolates from local labs sent?

A

Scottish Reference Labs

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5
Q

What do the reference labs do to isolates?

A

Collect them and perform further typing (linking of isolates across Scotland)

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6
Q

What is the role of health protection teams?

A

Receive reports of GI infections from local labs and send environmental health officers out to interview patients and find origin of infection

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7
Q

What is a common cause of healthcare-associated diarrhoea?

A

Clostridium difficile

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8
Q

What age of patients carry C diff as part of their normal bacterial flora?

A

Infants

Elderly (less commonly)

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9
Q

What causes the patient to become unwell with C diff.?

A

Production of toxins

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10
Q

What toxins are produced by C diff?

A 
Toxin A (enterotoxin)
Toxin B (cytotoxin)
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11
Q

What is the source/ vehicle of infection of C diff?

A

Present in bowel in small numbers in a number of people
When antibiotics prescribed, it kills off the normal competitive bowel flora allowing C diff to overgrow
Organism produces spores that survive in the environment dn are more resistant to disinfectants
Organism is transmitted from one patient to another

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12
Q

Symptoms of C diff?

A

Diarrhoea (sometimes bloody)
Abdo pain
Severe cases may progress to pseudomembranous colitis or bowel perforation

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13
Q

Management of C diff?

A

Depends on severity assessment:
Less severe = oral metronidazole
Severe = oral vancomycin

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14
Q

Prevention of C diff? (4)

A

Stewardship
Isolate patients
Hand washing (not alcohol)
Cleaning the environment

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15
Q

What type of bacteria is c diff?

A

Gram positive spore-bearing bacillus (spores more resistant to disinfectants)

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16
Q

There is no one good lab test for C diff? - true/ false

A

True

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17
Q

What lab tests can be performed for the diagnosis of C diff?

A

Screening test for presence of the organism (GDH)
If GDH positive, test for presence of toxin (toxin A and B)
Culture can be done if strain needs to be typed - not done routinely

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18
Q

Does the patient have c diff if the screening test is negative?

A

No

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19
Q

Does the patient have c diff is the screening test pos, toxin test pos?

A

Positive result

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20
Q

Does the patient have c diff is the screening test pos, toxin test neg?

A

Indeterminate result

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21
Q

What is the action plan if the lab tests for C diff are indeterminate?

A

Assess patient
Send repeat specimen (usually also indeterminate result also so have to make clinical decision - faeces usually smells of “horse shit” so ask experienced nurse if they think the patient has C diff

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22
Q

During what season are more cases of C diff seen?

Why is this thought to be the case?

A

Winter

Increased number of admission and possibly linked to the norovirus

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23
Q

Give an example of a hospital-acquired infection which is nationally surveyed?

A

C diff (can also occur in the community)

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24
Q

What 2 ribotypes of C diff are hyper-producers of toxin (leading to an increased morbidity and risk of death?

A

Ribotypes 027 and 078

25
Q

Viruses that cause diarrhoea? (2)

A

Rotavirus

Norovirus

26
Q

What is the commonest cause of Diarhhoea and vomiting in children

A

Rotavirus

27
Q

Do you get blood in the stool with rotavirus?

A

No

28
Q

How is roravirus spread?

A

Person-person spread, direct or indirect

29
Q

What months are the rotavirus more common in?

A

Winter months

30
Q

Do adults tend to experience severe symptoms with rotavirus?

A

No, they tend to get subclinical or mild symptoms (can be severe in immunocompromised children)

31
Q

How long does rotavirus tend to last?

A

Around 1 week

32
Q

Does the rotavirus have a high or low infectious dose?

A

Low

33
Q

What features make rotavirus easily spread?

A

Survives in the environment

Billions shed in faeces when diarrhoea

34
Q

Why do patients with rotavirus get dehydrated?

A

Decreased absorption of fluids and increased secretion in bowel causing dehydration

35
Q

What can patients develop after rotavirus that causes more diarrhoea?

A

Post-infection malabsorption

36
Q

How is rotavirus diagnosed?

A

PCR test on faeces

37
Q

What is the key management for rotavirus?

A

Rehydration (orally where possible)

38
Q

How is the rotavirus vaccine given?
doses?
Who is it not given to?

A

Orally (live attenuated vaccine excreted in the faeces)
2 doses, age 2 and 3 months
Not given to children > 24 weeks as high risk of intussusception

39
Q

What is the technical name for the winter vomiting disease?

A

Norovirus - can occur all year round

40
Q

what ages does norovirus tend to affect?

A

All ages (highly infectious)

41
Q

How is norovirus spread?

A

Faecal-oral/ droplets routes of spread

Person to person (or contaminated food/ water)

42
Q

Does norovirus have a low or high infectious dose?

A

Low

43
Q

Incubation period of norovirus?

A

Short - often

44
Q

What is the symptoms of norovirus?

A

Sudden onset explosive diarrhoea lasting 2-4 days

Vomiting leading to widespread contamination of environment = outbreaks

45
Q

Diagnosis of norovirus?

A

Faeces specimen or vomit swab for PCR

46
Q

Treatment of norovirus?

A

Rehydration (especially in the young and elderly)

47
Q

How long after cessation of symptoms of norovirus are you infectious?

A

Up to 48 hours (asymptomatic shedding)

48
Q

When are patients with a diarrhoeal illness most infectious?

A

When symptomatic with diarrhoea (remember not all diarrhoea is due to infection)

49
Q

What 2 infections should patients definitely be given a side room with?

A

C diffiile
Norovirus
(all patients with diarrhoea that might be infectious should be placed in a single room without toilet/ commode) - cohort nursing in bays may be required during outbreaks on wards when there is not enough single rooms available
Wards may be closed
Increased ward cleaning/ disinfection required

50
Q

What are 2 examples of GI infections with which patients may require admittance to the infectious diseases unit?

A

Salmonella

E coli O157

51
Q

What other infections (apart from diarrhoea organisms) mat be spread by the faecal-oral route?

A

Hepatitis A and E
Resistant bacteria that are carried in the GI tract e.g. vancomycin-resistant enterococci
Highly resistant Gram negative organisms (CPEs)

52
Q

What is cohort nursing?

A

All patients with the same infection nursed together with their own team of nurses

53
Q

What should be used to clean / disinfect a room after a patient with diarrhoea infection has stayed in it?

A

Hypochlorite

54
Q

What causes travel related diarrhoea? (3) - parasites

A

Amoebiasis
Giardiasis
Cryptosporidasis

55
Q

How to treat traveler diarrhoea?

A

Single dose of ciprofloxacin

Anti-diarrhoeals

56
Q

How to treat amoebiasis infection?

A

metronidazole + remove from lumen using diloxamide fruit or paromycin

57
Q

How is ameobas spread?

A

Faecal-oral route

58
Q

How are amoebas diagnosed?

A

Exam stool for ova

Study Notes - Gastroenterology (42 decks)

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