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Yr 5 > Microbiology Path > Flashcards

Microbiology Path Flashcards

1
Q

What is the definition of Diarrhoea?

A

Loose or watery stools at least 3x per day

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2
Q

What is the difference between small bowel and large bowel diarrhoea?

A
  • Small bowel = large volumes and bloaty pain with fever, blood, mucus and inflammatory cells rare (secretory)
  • Large bowel = smaller volumes and more severe abdominal pain with fever, blood, mucus and inflammatory cells more common (Secretory/Enteric)
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3
Q

Risk factors for Gastroenteritis?

A

Exposure related

  • Contact with infected individuals (often shared environments)
  • Travel (Where they went, where they stayed, what they did and what they ate/drank)
  • Occupation including antibiotic use
  • Animal contact (What animals and where?)

Host related

  • Extremes of age
  • Immunocompromised
  • MSM (Anal)
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4
Q

Describe the presentation and Tx of E/Coli Gastroenteritis?

A
  • Transmission = Faecally contaminated food/drink
  • Incubation period = 1-3 days
  • Presentation = Secretory diarrhoea lasting 2-3 days
    Enterotoxic = Travellers
    Enteropathogenic = infants
    Haemorrhagic = Haemolytic Uraemic Syndrome
    MENINGITIS IN CHILDREN
  • Tx = AVOID ANTIBIOTICS and give supportive care (fluids, electrolytes and nutritional support)
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5
Q

Describe the presentation and Tx of Vibrio Gastroenteritis?

A
  • Transmission = Oral-faecal (particularly contaminated seafood for Parahaemolyticus)
  • Incubation period = 1-3 days
  • Presentation = Large volumes of diarrhoea lasting ~3 days. Cholerae = Watery (secretory) as the pathogen opens cAMP channels leading to Cl- efflux and with it water and electrolyte loss with little/no fever. Parahaemolyticus = Inflammatory with fever +/- mucus and blood

Tx = Doxycycline

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6
Q

Describe the presentation and Tx of Clostridium Gastroenteritis?

A

Transmission = - Contaminated food sources ( Canned/Vacumm foods and meat kept warm )
- Post-antibiotic use where gut flora gets diminished (difficile)

Incubation
- Short for Perfringens (8-16hrs) - - N/A for Difficile

Presentation
- Watery diarrhoea (secretory if perfringens)
+ Fever, mucus and blood if Difficile (inflammatory)
- Paralysis if Botulinum

Duration

  • short (24-48hrs) if perfringens
  • Prolonged (up to 10-14 days) if Difficile

Key points
- C.Dif toxins = A/B cause inflammation and damage to mucosa with B = more virulent

Tx

  • Self-limiting and thus no Tx but supportive if Perfringens
  • Oral Vancomycin if C.Dif
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7
Q

Describe the presentation and Tx of Campylobacter Jejuni?

A

Transmission
- Animal faeces

Incubation
- 1-3 days

Presentation

  • Severe crampy abdominal pains with fever and foul-smelling diarrhoea +/- mucus/ blood
  • Typically lasts 1-7 days

Extra-GI manefestations
- Haemolytic anaemia, HUS, Glomerulonephritis, Erythema Nodosum and Reactive Arthritis

Tx

  • Normally self-limiting
  • Eryhtromycin if immunocompromised
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8
Q

Describe the presentation and Tx of S.Aureus Gastroenteritis?

A

Transmission
- Preformed toxins on unrefrigerated foods

Presentation

  • Very short incubation period (1-6hrs) with watery diarrhoea owing to the superantigen that binds MHC Class 2 and the TCR outside the antigen binding region to trigger cytokine release from CD4 +Ve cells
  • Fever and vomiting owing to cytokine release
  • Lasts 24-48hrs

Tx
- Self-limiting with supportive care

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9
Q

Describe the presentation and Tx of Shigella Gastroenteritis?

A

Transmission
- Faecal (raw vegetables and MSM)

Incubation
- 1-3 days

Presentation

  • Abdominal pain
  • 1/3 have watery diarrhoea, fever and vomiting
  • 1/3 - 1/2 have bloody diarrhoea

Extra-GI manefestation
- Glomerulonephritis, HUS
Eryhtema Nodosum, Reactive Arthritis and Meningitis

Tx
- typically self limiting within 7 days so supportive only

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10
Q

Describe the presentation and Tx of Salmonella Gastroeneteritis?

A

Transmisison

  • Non-typhoid = meat, unpasteurised dairy and eggs
  • Typhoid = Humans

Incubation

  • 1-3 days for non-typoid
  • more insidious for typhoid

Presentation

  • Non-typhoid = Inflammatory diarrhoea +/- vomiting
  • Typhoid = Enteric fever (High fevers with possible constipation preceding diarrhoea)

Extra-GI

  • Rose spots, splenomegaly and anaemia/leucopenia if Typhoid
  • Erythema Nodosum, Reactive Arthritis, Aortitis, Osteomyelitis and Deep tissue inflammation also possible

Dx

  • Stool antigen for non-typhoid
  • Blood culture for Typhoid (hypernatraemia also seen)

Tx

  • Non-Typhoid = self-limiting within 4-7 days
  • Typhoid = Ceftriaxone
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11
Q

Describe the presentation and Tx of Listeria Monocytogenes Gastroenteritis?

A

Transmission
- Refrigerated foods (can replicate at 4 degrees celcius)

Incubation
- within a day

Presentation

  • Inflammatory diarrhoea
  • PARTICULARLY IMPORTANT IN PREGNANT WOMEN AS MOTHER MAY BE RELATIVELY OK BUT FOETUS MAY NOT
  • Also seen in the immunocompromised
  • Duration of illness variable
  • MENINGITIS IN CHILDREN/INFANTS

Tx
- Amoxicillin

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12
Q

Describe the presentation and Tx of Yersinia Gastroenteritis?

A

Transmission
- Animals, typically pork

Incubation
- Long = 4-6 days

Presentation

  • Inflammatory diarrhoea
  • Abdominal pain
  • May persist for 1-3 weeks

Extra-GI
- All except Meningitis and HUS

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13
Q

Describe Parasitic Gastroenteritis?

A

Transmission

  • Oral-faecal ingestion of cysts containing trophozoites
  • Once inside the body, the parasites excyst and attach to areas of the body to which they have a tropism ( Giardia = Duodenum, Cryptosporidium = Jejunum and Entamoeba = Liver (non-motile) or GI tract (motile))

Incubation
- Long = days to weeks

Presentation

  • Flatus, bloating and diarrhoea in general
  • Liver abscess = no diarrhoea, fever and RUQ pain if non-motile Entamoeba
  • Severe = Cryptosporidium

Ix

  • Stool
    • Microscopy for Giardia = pear-shaped with 2 nuclei and 4 flagella or ELISA
    • Iodine and Trichrome stains for Entamoeba

Tx

  • Metronidazole for Giardia
  • Metro + Paromomycin for Entamoeba
  • Reconstitute immune system for Cryptosporidium
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14
Q

Describe Viral Gastroentritis?

A

Transmission

  • Often Oral-Faecal
  • Seafood suggests Norovirus

Incubation

  • Short (10-16hrs for Enteric viruses)
  • Longer for Norovirus = 24-48hrs

Presentation

  • Watery diarrhoea
  • Fever
  • Vomiting suggests Norovirus
  • URTI/Conjunctivitis suggests Adenovirus

Tx
- Supportive

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15
Q

What are the Extra-GI manifestations of Gastroenteritis and what are the associated organisms?

A

o Aortitis, Osteomyelitis and deep tissue inflammation = Salmonella and Yersinia
o Haemolytic anaemia = Campylobacter and Yersinia
o Glomerulonephritis = Campylobacter, Shigella and Yersinia
o HUS = E.Coli and Shigella
o Erythema Nodosum = Campylobacter, Shigella, Yersinia and Salmonella
o Reactive Arthritis = Campylobacter, Shigella, Yersinia, Salmonella and Giardia
o Meningitis = Shigella, E.Coli and Listeria Monocytogenes

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16
Q

Describe health promoting behaviours in respect to Gastroenteritis?

A 
Targets for health promotion
o	Breast/Bottle feeding and food handling
o	Safe water
o	Waste disposal
o	Travel precautions
o	Isolation and PPE
o	PHE notification (Hx is very important)
o	GOOD HAND WASHING
-	Vaccinations
PHE notifiable GE pathogens
o	Campylobacter
o	Clostridium 
o	Yersinia
o	Vibrio
o	Salmonella
o	Listeria Monocytogenes

Yr 5 (11 decks)

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