Non-inflammatory acute diarrhea Flashcards
Incubation = 12-48 hours and resolution in 1-3 days
Nausea, vomiting, watery diarrhea, fever, myalgia, abdominal cramps
– Daycare, nursing homes, schools, cruise ships
November- April
Virus spread through fecal-oral route with shellfish + fecally contaminated foods touched by infected food handlers
MCC of acute gastroenteritis
norovirus
norovirus has +/- stool cultures
negative
Incubation = 1-3 days, lasting 4-8 days
Acute onset, vomiting, watery diarrhea
6 months - 2 years (young, unimmunized children)
Viral - MCC of diarrhea in infants and young children
Fecal-oral route
rotavirus
Stool PCR if needed to confirm
Vaccines available!
→ rotateq = 3 doses at 2m, 4m, 6m
→ rotarix = 2 doses at 2m, 4m
rotavirus dx
Incubation = 1-3 weeks
Acute phase = diarrhea is profuse and watery. Generally self-limited, days or weeks
Rarely bloody or mucus
50% are asymptomatic, but some can become cyst passers (10%) and 25-50% develop an acute diarrheal syndrome
Chronic disease = abdominal cramping, bloating, flatus, malaise, anorexia
Fever and vomiting uncommon
Stools = greasy, frothy, foul smelling w/o blood, pus, or mucus
Weight loss, malabsorption
Weeks - months
giarda
Poor sanitation - young children, outbreaks in households, day care centers, residential facilities
Travelers to endemic areas
Drinking from contaminated water during recreational wilderness travel
Partners performing anal intercourse
Impaired immunity
giarda
Giardia lamblia protozoa in upper small intestine: flagella
Spreads through trophozoite and cyst
Cyst = infectious orally and hardy, can survive months in cold water
Fecal-oral contamination, water and food contamination, contact
MCC parasitic protozoan infection
Mountain stream water, camping/backpacking, beavers
giarda
PCR stool assays
Antigen stool essays
Dx = wet mount of stool w/ mobile trophozoites or cysts
giarda
how do you treat giarda
Metronidazole, tinidazole
Paromomycin is safe in pregnancy
Symptomatic but studies negative, consider empiric tx
Household/day care should be tested & treated
Water must be filtered, not just chlorinated – boil water for 1 minute, disposal of diapers/good hand hygiene
Diarrhea, loss of appetite, cramping, bloating, increased gas, nausea, fatigue, vomiting, low grade fever
Tropical-subtropical regions
US = imported produce
Parasite transmitted via food or water (fecal-oral)
cyclospora
Incubation 1-8 hours with symptoms occurring FAST (30min-6 hours): prominent nausea, vomiting, cramps, diarrhea
Brief → <24 hours
Bacterial foodborne illness in meat, dairy, eggs, and bakery products, salads, creams producing enterotoxin
staph aureus
Diarrhea, abdominal cramps, vomiting
~ 24 hours (short incubation period) with prominent nausea, vomiting with abdominal cramping
Bacterial foodborne with foods left out too long (fried rice)
bacillus cereus
Incubation 8-16 hours with abrupt onset of profuse diarrhea, abdominal cramps, nausea, vomiting
Bacterial foodborne in raw meat and poultry (rewarmed meat and poultry dishes)
closridium perfringens
Incubation 1-3 days with abrupt onset of watery diarrhea, abdominal cramping, vomiting
Unpeeled fruits, unsanitary drinking water
Traveling!!
Bacterial – MCC of traveler’s diarrhea
Contaminated food and water
enterotoxicgenic e coli
how do you treat severe ETEC
fluoroquinolones
Acute onset of severe, frequent watery diarrhea
~1L / hour
Stool = gray, turbid, watery, without odor, blood, pus “rice water stool”
Dehydration + hypotension develop
Can be DEADLY
cholera
Crowding, war, famine, inadequate sanitation
Vibrio cholerae causing hypersecretion of water. Common from shellfish or contaminated water
cholera
how do you treat cholera
Mild or moderate = oral rehydration is adequate
½ tsp table salt + 6 tsp of sugar + 1L water
IV fluids for severe hypovolemia (lactated ringers)
Antimicrobial therapy = shorten illness course for severely ill patients: tetracyclines, macrolides, fluoroquinolones
