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MICRO ADYA > Microbiology 6 - GI infections > Flashcards

Microbiology 6 - GI infections Flashcards

1
Q

In a febrile patient with a GI infection, what are the key differentials?

A
  1. Inflammatory diarroea
  2. If no diarrhoea - enteric fever (typhoid/ salmonella)
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2
Q

In an afebrile patient with a GI infection, what is the top differential?

A

Secretory diarrhoea due to toxins (eg cholera)

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3
Q

What is the incubation period of campylobacter?

A

1-10 days

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4
Q

What is the incubation period of bacilus cereus?

A

1-6 hours

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5
Q

Why does staph aureus food poisoning produce such rapid symptoms?

A

Toxin is pre-formed

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6
Q

What are the key cytokines involved in Staph aureus food poisoning?

A

IL-7 and IL-2

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7
Q

Describe the symptoms of S aureus food poisoning

A

Vomiting
Waterey, non-bloody diarrhoea

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8
Q

Describe the different toxins produced by bacilus cereus

A

Heat-stable toxin causes emesis
Heat-labile toxin causes diarrhoea
Only the heat-labile toxin is destroyed upon heating

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9
Q

Describe the diarrhoea produced by bacilus cereus

A

Waterey, non-bloody

**after reheating rice/chinese takeout*

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10
Q

In what type of food might clostridia botulinum be found?

A

Honey

and vacuum packed foods

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11
Q

What type of clostridia spp causes food poisoning?

A

Clostridia perfringens

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12
Q

In what sort of food is clostridia perfringens found?

A

Re-heated meat

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13
Q

Which organism causes pseudomembranous colitis?

A

Clostridium difficile

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14
Q

Which diarrhoeal disease is associated with antibiotic use?

A

Pseudomembranous colitis caused by C. difficile

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15
Q

What type of symptoms does listeria monocytogenes poisoning cause?

A

Febrile gastroenteritis
Waterey diarrhoea

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16
Q

Recall 2 sources of listeria poisoning

A 
Unpasteurised dairy 
Refringerated foods (eg sandwiches)
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17
Q

Is listeria alpha or beta haemolytic?

A

Beta haemolytic

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18
Q

What is the causative organism in ‘traveller’s diarrhoea’?

A

Enterobacteriacae (usually the toxogenic form, ETEC)

enterotoxogenic escherchia coli

escherichia coli

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19
Q

What organism causes haemolytic uraemic syndrome?

A

EHEC enterobacteriacae

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20
Q

Recall one very important thing to avoid in the management of enterobacteriacae poisoning

A

Antibiotics

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21
Q

Recall 3 worrying species of salmonella

A

S typhi
S enteritidis
S cholerasuis

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22
Q

What symptoms are caused by S typhi infection?

A

Bactaraemia
Constipation and fever
Splenomegaly and ROSE SPOTS

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23
Q

What are the 2 key forms of shigella that cause disease in humans?

A 
S dysenteriae 
S flexneri (associated with MSM)
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24
Q

What disease pattern does shigella infection cause?

A

Dysentry

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25
Q

How should shigella infection be managed?

A

Avoid antibiotics
If really necessary, go for ciprofloxacin

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26
Q

What is the typical stool appearance in Vibrio cholerae infection?

A

Rice water

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27
Q

Which organism is most likely to cause cellulitis in a scuba diver/shellfish handler?

A

Vibrio vulnificus

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28
Q

On what sort of agar can vibrio spp be grown?

A

Salty agar

**vibrio, shellfish, salty

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29
Q

For how long can campylobacter symptoms last?

A

Up to 20 days

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30
Q

What is one key serious complication of campylobacter infection?

A

Guillan Barre syndrome

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31
Q

What is the symptom of “flask-shaped ulcer” pathognemonic for?

A

Entamoeba histolytica infection

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32
Q

What symptoms does E. histolytica infection cause?

A

Dysentry and flatulence

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33
Q

How should E. histolytica infection be managed?

A

Metronidazole

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34
Q

How can giardia infection be investigated?

A

String test

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35
Q

How should giardia infection be treated?

A

Metronidazole

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36
Q

In which patient group does cryptosporum parvum cause symptoms, and what are those symptoms?

A

The immunocompromised
Severe diarrhoea

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37
Q

Recall the 1st and 2nd line treatments for clostridium difficile

A
  1. Metronidazole
  2. Vancomycin
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38
Q

Definition of diarrhoea

A

Loose or watery stools at least 3 times a day.

Can be acute, persistent or chronic

a) acute: < 2 weeks
b) persistent: between 14-30 days
c) chronic: over 1 month

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39
Q

Small bowel vs large bowel diarrhoea

A

Small bowel:

  • often large volumes
  • often very watery, with gas and bloating
  • often no accompanying fever
  • no blood, mucous or inflammatory cells

Large bowel

  • small volumes
  • not watery. often accompanied with PAIN
  • often with accompanying fever
  • often has blood, mucous or inflammatory cells
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40
Q

secretory diarrhoe vs enteric fever vs inflammatory diarrhoea?

A

Secretory diarrhoea- due to toxin production

  • Change in stools- profuse watery diarrhoea
  • No fever
  • No WBC in stool

**basc just irritation to GI tract; not very unwell**

Inflammatory diarrhoea

  • Change in stools
  • Fever present
  • WBC in stool

**bacteria trying to actually invade the GI tract; unwell and lots of GI symptoms**

Enteric fever

  • No change in stools
  • Fever present
  • WBC in stool present

**unwell but no GI symptoms**

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41
Q

Which organisms cause persistent or chornic diarrhoea?

A
  1. entameboa histolytica
  2. giardia lamblia
  3. cryptosporidium
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42
Q

Which organisms cause dysentry?

A

CHESSY

Campylobacter

Haemorrhagic E. Coli

Entamoeba histolytica (parasite)

Salmonella

Shigella

Yersinia enterocolitica

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43
Q

Which bacteria causes swinging fevers?

A

E. Histolytica

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44
Q

Which organisms cause abdominal pain?

A

E.Coli O157

Salmonella

Shigella

Campylobacter

Yersinia

noncholera Vibrio species

Clostridium difficile

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45
Q

Which organism causes persistent abdominal pain and fever?

A

Yersinia Enterocolitica

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46
Q

Which organisms cause nausea and vomiting lasting less than 24 hours?

A

These are the short incubation emetic syndromes.

  1. B Cereus
  2. Toxins of Staph Aureus
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47
Q

Typical Sx of clostridium perfringens

A

Abdominal cramps and watery diarrhoea

(non bloody)

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48
Q

Typical symptoms of Staph Aureus Gastroenteritis

A

Vomiting>diarrhoea

can cause systemic toxicity - tachycardia and hypotension

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49
Q

Typical symptoms of B cereus Gastroenteritis

A

Vomiting first

Followed by diarrhoea after 6 hours

*non bloody diarrhoea

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50
Q

Typical symptoms of cholera infection

A

Rice water stools

Severe watery diarrhoea

Sometimes afebrile

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51
Q

Symptoms of salmonella

A

Bloody diarrhoea (sometimes)

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52
Q

Symptoms of E Coli

A

Traveller’s diarrhoea: non-bloody

Bloody diarrhoea: haemorrhagic E. Coli

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53
Q

Symptoms of Shigella

A

Bloody diarrhoea

More common in MSMs

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54
Q

Symptoms of camylobacter

A

Bloody diarrhoea

Prodromal illness

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55
Q

Symptoms of giardia lamblia

A

bloating

flatulence

chronic diarrhoea

non-bloody diarrhoea

malabsorption

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56
Q

Symptoms of entameboa histolytica

A

Bloody diarrhoea

Liver/lung/brain abscesses

Swinging fevers

Flask shaped ulcers in the intestine

Flatulence

Tenesmus

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57
Q

Which organism causes vomiting and non-bloody diarrhoea for 1-2 days?

A

Norovirus

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58
Q

Which organisms cause long incubation emetic syndromes?

A

B cereus

C perfringens

Diarrhoea+adominal cramping 1-2 days

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59
Q

Which organisms cause Aortitis, Osteomyelitis, deep tissue infection (2):

A

salmonella

Yersinia

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60
Q

Which organism cause haemolytic anaemia?

A

Camylobacter

Yersinia

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61
Q

Which organisms cause gloerulonephritis?

A

Shigella

Campylobacter

Yersinia

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62
Q

Which organisms cause HUS?

A

STEC- shiga toxin producing E Coli

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63
Q

which organisms cause Erythema nodosum (4):

A

Yersinia

Campylobacter

Salmonella

Shigella

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64
Q

Which organisms cause reactive arthirtis

A

Salmonella

Shigella

Campylobacter

Yersinia

65
Q

WHich organism cause meningtis?

A

LIsteria and salmonella

More at risk in young babies

66
Q

Characteristics of B cereus

67
Q

how does b cereus transmit?

A

reheating rice causes spore germination

68
Q

WHat type of organism is staph auerus?

69
Q

Transmission of staph auerus

A

Spread from skin of food handlers

causing food poisoning

70
Q

Gram stain of clostridium species

A

Gram positive anaerobes

71
Q

Clostridium botulinism

72
Q

Clostridium perfringens

A
  • Source : reheated food (meat)
  • Normal flora of colon but not small bowel, where the enterotoxin acts (superantigen)
  • Incubation 8-16hrs
  • Watery diarrhoea, cramps,little vomiting lasting 24hrs
73
Q

Clostridium difficile

A
  • ¡It is not an invasive disease and non-toxin producing strains do not often cause disease but can colonise the gut and asymptomatic shedders of spores can continue to act as a reservoir for infection
  • C.difficle produces two toxins; Toxin A, an enterotoxin and Toxin B, a cytotoxin
    • Toxin A causes inflammation with intestinal fluid secretion and damage to the mucosa
    • Toxin B, more potent than toxin A acts as a virulence factor
  • HAI
    • Antibiotic related colitis
74
Q

Which antibiotics cause C difficile colitis

A

Cephalosporins

Clindamycin

Ciproflocaxin

Co-amoxiclav

75
Q

Which toxin of C. Difficile is entertoxic?

A

Toxin A

(Toxin B is the virulence factor)

76
Q

Management of C difficle colitis

A

Stop antibiotics

PO metronidazole

If doesn’t work–> Vancomycin

77
Q

Characteristics of vibrio bacteria

A

Gram negative (V for VIOLENT)

Comma shaped

Late lactose fermenters

Oxidase positive

78
Q

Gram stain of vibrio cholerae

A

Gram negative anaerobe

  • comma shaped
  • late lactose fermenter
  • oxidase positive

GRAM NEGATIVE ROD

79
Q

Transmission of vibrio cholerae

A

Faeco-oral

Faecally contaminated water- eg shellfish, shrimp etc

80
Q

Pathophysiology of diarrhoea caused by Vibrio cholerae

A

Produce toxins A and B- bOTH ARE ENTERTOXINS

They cause chloride channel opening - loss of chloride ions into the intestine–> water follows

MASSIVE watery diarrhoea (rice water stools)

81
Q

What type of organism is Listeria?

A

Gram positive

Facultative intracellular rod bacteria

B Haemolytic

Ausculin positive

Tumbling motility

82
Q

How is listeria transmitted?

A

Listeria grows in refrigerated foods - unpasteurised milk, vegetables,

83
Q

Symptoms of listeria monocytogenes

A

GI watery diarrhoea

cramps

headache

fever

little vomiting

84
Q

Treatment of listeria

A

Amoxicillin and gentamicin

85
Q

What are the Enterobacteriaceae?

A

E Coli

Salmonella

Shigella

Klebsiella

Yersinia

86
Q

CHaracteristics of enterobacteraciea?

A

Gram negative

Facultative anaerobes

Glucose/ lactose fermenters (LF)

Oxidase negative

87
Q

4 types of E. Coli

A
  1. ETEC: enterotoxiogenic
  2. EPEC: enteropathogenic
  3. EIEC: enteroinvasive E. Coli
  4. EHEC: enterohaemorrhagic E. Coli
88
Q

ETEC

A

toxigenic

main cause of traveller’s diarrhoea

89
Q

EPEC

A

pathogenic

infantile (paediatric) diarrhoea

90
Q

EIEC

A

invasive

dysentery-like illness

91
Q

EHEC

A

also called Shiga-toxin-producing E. coli or STEC

Often people know this as E. coli O157:H7 EHEC

shiga-like verocytotoxin → HUS

**May present with diarrhoea + bruising (suggesting thrombocytopaniea)

92
Q

How do you treat E. Coli diarrhoea?

A

Self-limiting

avoid antibiotics

if really necessary then ciprofloxacin

93
Q

Salmonella features

A
  • Non lactose fermenters,
  • H2S producers, TSI agar,
  • XLD agar,selenite F broth

gram negative bacili

  • Facultative anaerobes
  • Lactose fermenters
  • Oxidase-negative
94
Q

Antigens produced by salmonella

A
  • cell wall O (groups A-I)
  • flagellar H
  • capsular Vi (virulence, antiphagocytic)
95
Q

Main species of Salmonella

A
  1. S. typhi (and paratyphi) - causes enteric fever
  2. S.enteritidis - causes dysentry
96
Q

Presentation of salmonella typhi

A
  1. Slow onset- symptoms occur after 1st or 2nd week
  • Fever and constipation
  • DON’T HAVE DIARRHOEA
  1. Extra-intestinal manifestations (4):
  • splenomegaly
  • rose spots
  • anaemia
  • leukopaenia
  1. Signs (3):
  • bradycardia
  • haemorrhage
  • perforation of the bowel
97
Q

Treatment of salmonella typhi

A

IV Ceftriaxone –> PO azithromycin

98
Q

Presentation of salmonella enteriditis

99
Q

Tx of salmonella enteriditis

A

Causes classic enteroclitis

Treatment is usually self-limiting

Path guide: can treat with ceftriaxone if required

Pathsoc: cipro

**learn cipro

100
Q

Characteristics of shigella

A

gram negative bacillus (like the other enteroBacter)

101
Q

Presentation of shigella

102
Q

Treatment of shigella

A

Self-lmiting

May require ciprofloxacin if immunosuppressed or MSM (risk of Shigella flexneri which is dangerous)

103
Q

Camypylobacter characteristcs

A
  • Gram-negative ROD
  • Comma-shaped
  • Microaerophilic
  • Oxidase-positive
  • Motile

camping is AWFUL - NEGATIVE

104
Q

Campylobacter transmission

A
  • faecal-oral transmission
  • contaminated food and water with animal faeces
  • Associated with BBQs
105
Q

Presentation of campylobacter

A
  • watery, foul smelling diarrhoea:
    • Loose stools occur > 10 x day
  • fever
  • bloody stool:
    • Stools may become bloody from 2-3rd day onwards
    • in those with the plasmid PVir which correlates with more SEVERE disease
  • severe crampy abdominal pain
106
Q

Tx of campylobacter

A

Self limiting

Treat with cipro or erythromycin if immunocompromised

**acc to passmed, clarithromycin is first line. but check…**

107
Q

Yersinia enteroclitica characteristcs

A

example of enterobacter hence:

Gram-negative, bacillus

108
Q

Testing for Gastroenteritis

A

Stool samples

a) culture dependent: microscopy
b) culture independent: PCR

109
Q

Why do you need 3 stool samples for parasitic infections?

A

Intermittent shedding of ova

110
Q

Antibiotics for GI infections

111
Q

E. histolytica characteristics

112
Q

Aetiology of E. Histolytica

113
Q

Presentation of E. histolytica

114
Q

Giardia lamblia: microscopic features

A
  • trophozoite “pear shaped”
  • 2 nuclei
  • 4 flagellas and a suction disk
  • Ingestion of cyst from fecally contaminated water,food
115
Q

Giardia Lamblia

A
  • Travellers, hikers, day care, mental hospitals, MSM
  • foul smelling non bloody diarrhoea, cramps
  • flatulence, no fever
  • Diagnosis : stool micro, ELISA, “string test”
  • Treatment :metronidazole
116
Q

Example of protozoan diarrhoea

A

Cryptosporidium parvum

117
Q

Characteristics of cryptosporidium

A
  • Infects the jejunum
  • Severe diarrhoea in the immunocomromised
  • Oocysts seen in stool by modified Kinyoun acid fast stain
  • Treatment : reconstitution of immune system
118
Q

Norovirus diarrhoeal illness

A
  • Outbreaks
  • Low ID (18-1000 viral particles)
  • Environmental resilience (0-60 ºC)
  • No long term immunity
  • GII.4 currently predominant strain
119
Q

Rotavirus diarrhoea

A
  • dsRNA “wheel like”
  • Mean duration of symptoms for 3-8 days
  • Population: occurs in children aged 6 months to two years + occasionally in the elderly
  • When: Often year round in tropical climates and in the winter months in temperate areas
  • Presentation:
    • Vomiting is less of a prominent feature than in norovirus although it can be difficult to distinguish between them
    • Replicates in mucosa of small intestine
    • Secretory diarrhoea, no inflammation
    • Watery diarrhoea by stimulation of enteric nervous system
120
Q

Can you be immune to rotavirus?

A

Yes

  • By age 6 most children worldwide have antibodies to at least one type¡
  • Exposure to natural infection twice confers lifelong immunity
121
Q

Adenovirus diarrhoea

A
  • can affect <2yo and elderly
  • non-bloody diarrhoea
122
Q

Examples of vaccines against GI bacteria

A

Cholera

Salmonella Typhi

Rotavirus

123
Q

Notifiable organisms

A

Campylobacter

Clostridium sp.

Listeria monocytogenes

Vibrio

Yersinia

124
Q

Definition of gastroenteirtis: duration

A

>2 weeks of symptoms

125
Q

Which extra intestinal manifestation is comonest with S. Typhi?

126
Q

Complications of campylobacter

A

GBS- guillan barre syndrome- tingling

Reiter’s syndrome: can’t see, can’t pee, can’t climb a tree

127
Q

Treatment of parasitic infections

A

Generally metronidazole

128
Q

Crampy adbominal pain + diarrhoea (bloody or non-bloody)

A

Campylobacter

129
Q

Treatment for c. jejuni?

A

Erythromycin or cipro if in first 5 days

130
Q

Summary of gram stains of organisms and buzz words

131
Q

Which organisms cause secretory diarrhoea?

A

Cholera, ETEC, EPEC, viruses

(also Staph aureus- toxins A and B)

132
Q

Which organisms cause inflammatory diarrhoea?

A

Campylobacter jejuni, Shigella, non-typhoidal Salmonella, EIEC

133
Q

Which organisms cause enteric fever?

A

Typohoidal salmonella, Yersinia, Brucella

134
Q

C. botulinim paralysis vs GBS paralysis

A

Botulinum- descending paralysis

GBS- ascending paralysis

135
Q

Reheated meats, 8-16hrs incubation

Watery diarrhoea + cramps, lasts 24hrs.

Also causes gas-gangrene

A

C. perfringens

136
Q

B. cereus treatment

A

Self-limitimg

137
Q

What type of diarrhoea does B. cereus cause?

A

Watery non-bloody diarrhoea

138
Q

Two forms of B. cereus

A

a) short incubation - sudden vomiting –> non-bloody watery diarrhoea
b) long incubation –> watery non-bloody diarrhoea

**basc short incubation has vomiting but long incubation has no vomiting**

139
Q

Staph aureus presentation

A

Short incubation

Prominent vomiting, watery diarrhoea

140
Q

Tx of staph aureus diarrhoea

A

Self-limiting

141
Q

Which vibrio species is transmitetd through raw seafood and is common in Japan?

A

Parahaemolyticus

142
Q

Treatment of vibrio diarrhoea

A

Self-limiting

143
Q

Which are the only bacterial causes of diarrhoea you need to treat with antibiotics?

A

1. C difficile - metronidazole –> vanocmycin

2. Enterobactericiae- ceftriaxone (salmonella) or ciprofloxacin (e coli, shigella)

ESS- cipro, ceftriaxone (typhi), cipro (enteritidis)

3. C jejuni- erythromycin or cipro if within 5 days (**acc to quesmed- there is a lot of resistance to cipro which is why you give erythromycin)

4. Listeria- ampicillin

144
Q

C jejuni description

A
  • Comma-shaped
  • Microaerophilic
  • Oxidase-positive
  • Gram-negative
  • Motile

gram negative rod

**because when you go camping you light fire using logs/rods**

146
Q

Tx of cryptosporidium parvum

A

paromomycin

147
Q

3 main viral causes of diarrhoea

A

Norovirus

Adenovirus

Rotavirus

(NAR)

–>all cause secretory diarrhoea which is self-limiting

norovirus in adults; adenovirus and rotavirus in children.

148
Q

Diarrhoea and vomiting after raw eggs

A

salmonella enterica

149
Q

Summary of key incubation periods to know

A

1-6 hrs: Staphylococcus aureus, Bacillus cereus*

12-48 hrs: Salmonella, Escherichia coli

48-72 hrs: Shigella, Campylobacter

> 7 days: Giardiasis, Amoebiasis

150
Q

host related risk factors for developing GI infections

A
  • Young children and elderly
    • Less seen in infancy but can see some
  • Immunosuppressed patients
  • Men who have sex with men (MSM) – shigella
  • Anal-genital, oral-anal, or digital-anal contact
  • Patients with haemochromatosis or haemoglobinopathy
151
Q

incidences of bacterial vs viral Gastroenteritis

A

incidence of bacterial gastroenteritis is far less than viral gastroenteritis

152
Q

Bacillus cereus: complications:

A
  • cause bacteraemia in vulnerable people
  • Can cause cerebral abscesses
153
Q

list some organisms with incubation period of within 1 day

A
  • staphylococcus
  • clostridium perfringens
  • norovirus
  • viruses (Rotavirus, enteric adenovirus)
  • listeria monocytogenes
  • bacillus cereus

they typically have preformed toxins

154
Q

list some organisms with incubation period after day 1

A

enteric pathogens

  • Salmonella, shigella, campylobacter, enterotoxigenic E. coli
  • **so basically the bacteria as part of CHESSY (except ETEC not EHEC)***
155
Q

list some infections with incubation period up to 4-6 days after or weeks

A
  • Think about parasites + C.difficile

cryptosporidium parvum

Giardia

Yersnia

156
Q

key differences between enteric fever and inflammatory diarrhoea

A

inflammatory diarrhoea = exudative diarrhoea

enteric fever = interstitial inflammation

157
Q

how many stool samples need to be sent in parasitic infections

A
  • In parasitic infections, intermittent shedding occurs so need to send THREE stool samples to see if it can be found
158
Q

Giardiasis vs ameobiasis: bloody vs non bloody?

A

Giardiasis: tends to be non bloody

Ameobaisis: tends to be bloody

159
Q

WHich organism causes diarrheoa and flu like illness?? ** confirm

A

Campylobacter

MICRO ADYA (22 decks)

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