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House Microbiology > Pseudomembranous Colitis and other Clostridiodes difficile Infections and Cholera > Flashcards

Pseudomembranous Colitis and other Clostridiodes difficile Infections and Cholera Flashcards

1
Q

Cholera and Clostridiodes difficile – both cause gastrointestinal infections

T/F

A

T

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2
Q

Cholera is caused by ________

A

vibrio cholerae

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3
Q

Clostridoides difficile causes a range of gastrontestinal infections including __________

A

pseudomembranous colitis

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4
Q

What is Cholera?

(acute or chronic?) and (mild or severe?) diarrheal disease of Public health importance

Primarily transmitted within the community

Caused by _____________ contaminated with the bacterium Vibrio cholerae.

A

Acute ; severe

consuming food and water

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5
Q

Cholera

Affects only adults

A

Affects both Adults and Children.

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6
Q

Incubation Period for cholera is ______ to ________ after exposures

A

12hrs to 5 days

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7
Q

Vibrio Cholera

These are Gram-__________ ——- .

———- shaped

(Obligate or facultative?) (aerobes or anaerobes?) which are oxidase ________.

A

negative; rods

comma

facultative

anaerobes; positive

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8
Q

The most important vibrio, __________

A

Vibrio cholerae

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9
Q

Vibrio Cholera

V. cholerae is found in the ______ of an infected individual and ends up in the _________ if _______ is untreated.

Transmission – by drinking contaminated water or Contaminated food

Survives in fresh water and in salt water Primarily a disease of _________..

A

feces

water supply; sewage

poverty

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10
Q

Vibrio Cholerae
There are many serogroups of V. cholerae,

Only two –_____ and _______ – cause outbreaks.

A

O1 and O139

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11
Q

Vibrio Cholerae

V. cholerae ____ - caused all recent outbreaks.
V. cholerae _____ – first identified in Bangladesh in 1992 – has never been identified outside Asia.

_____ difference in the clinical presentation of the two sero-groups.

A

O1

O139

No

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12
Q

Vibrio Cholerae

V. cholerae O1 - caused ________

V. cholerae O139 – first identified in _______ in 1992 – has never been identified outside Asia.

A

all recent outbreaks.

Bangladesh

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13
Q

Epidemiology of Cholera

Cholera can be __demic or ___demic

A

en

epi

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14
Q

Cholera

Endemic: defined as _______________ cases were detected during the ___________ with evidence of ________

Epidemic:

•In cholera endemic countries an outbreak represents a _______________________

•In a non-endemic country an outbreak is defined as the occurrence of ____________________ case of cholera with evidence of ___________ in an area where there is not usually cholera.

A

confirmed cholera

last 3 years; local transmission

greater than expected number of cases.

at least 1 confirmed ; local transmission

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15
Q

Transmission of cholera

Linked to inadequate access to ________ and sanitation services
Drinking contaminated water
Eating contaminated food
Direct Person to person uncommon in the community

About ____% of people infected with cholera do not develop any symptoms and remain carriers

Pathogens persist in faeces for ____ to ____ days and are shed into the environment

A

clean water

75

1 to 10

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16
Q

Factors that Aid Transmission of cholera

•Pathogen factors:
________ of ______ in the environment.

Presence of a ___________

•Reservoir and carrier state:
_____ is the only known reservoir

convalescent carrier may be infectious for __________

chronic carriers can remain infectious for _________, up till _______

A

Persistence of bacteria

potent exotoxin.

Man; 2-3weeks

a month; 10 years.

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17
Q

Factors that Aid Transmission of cholera

•Host factors:
Over crowding
Cholera incidence higher among lower socio economic groups which may be attributable to _________

•Environmental factors:
poor environmental sanitation; this results in contamination of food
and water.

A

poor hygiene.

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18
Q

Pathogenesis Of cholera

Once in the gut,

Organism _______________ of the intestine without __________.

______________ is important in pathogenesis.

__________ (_________) is then secreted and is chromosomally encoded and contains __________________ (_______)

A

adheres to the epithelium

penetration; Adhesion to the microvilli

Choleragen ; Cholera toxin

two types of subunit (A and B).

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19
Q

Pathogenesis of cholera

The B subunit binds to _______ on epithelial cell surfaces allowing ______________

The A subunit catalyses _________ of a regulator complex which in turn activates ________ present in the cell membrane of the epithelium of the gut.

The overproduction of ______ stimulates ______________________ into the lumen.

Results in _______ and death (without treatment) result.

A

gangliosides; internalization of the A subunit.

ADP-ribosylation ; adenylate cyclase

cyclic AMP

massive secretion of ions and water

dehydration

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20
Q

Clinical presentation of cholera

________ stool (_______)

Vomiting,Leading to ________________

Less than ____% of total cholera cases develop into severe cases of dehydration

Without any treatment, deaths may reach as high as 50% during outbreaks

A

Watery Colorless; rice water

moderate to severe dehydration

10

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21
Q

Treatment of cholera

__________ is the major component of treatment.

Antibiotic therapy (including ________) is additionally used.

A

Fluid replacement

tetracycline

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22
Q

Vaccination against cholera is completely effective generally recommended.

T/F

A

F

Vaccination against cholera is only partially effective and not generally recommended. - commonly used by international travelers.

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23
Q

Cholera Vaccine is commonly used by international travelers.

T/F

A

T

24
Q

Safe oral cholera vaccines should be used in conjunction with ________ and _________ to control cholera outbreaks and for prevention in areas known to be high risk for cholera

A

improvements in water and sanitation

25
Q

Pseudomembranous colitis

________ of the _____ due to an overgrowth of Clostridioides ________
pseudomembranes

Characterized by elevated ________ plaques that ______ to form _____________ on the mucosa.

Common cause of diarrhea after ____________

More common in people over _____yrs

A

Inflammation; colon

difficile; yellow- white

coalesce; pseudomembranes

antibiotic use

65yrs

26
Q

Clostridiodes difficile

Gram ________,

_______ oval spores, capsule in some

most are (motile or non-motile?) .

Ubiquitous especially in ___________

A

positive

subterminal

Motile ; hospital environment

27
Q

Clostridiodes difficile

Serogroups:list them

Virulence factors:——- and ______

A

Toxin A & Toxin B,

28
Q

Clostridiodes difficile

Toxin A is _______ toxin,
Toxin B is _______toxin and both work together in-vivo.

A

entero

cyto

29
Q

Risk factors of Pseudomembranous colitis
I
taking _______

Staying in the hospital or a nursing home

Increasing age, especially over ____ years
Having a weakened immune system
Having a colon disease, such as inflammatory bowel disease or _______

Undergoing intestinal ________

Receiving chemotherapy treatment for cancer

A

antibiotics

65

colorectal cancer

surgery

30
Q

Pathogenesis:

C. difficile spores -resistant many common disinfeprofessionalsctants

•Can be no
Disturbance of normal colonic flora with antibiotics, cytotoxic drugs, surgery, instrumentation
•
Eg_____,______ - devastating effect on the flora of the colon.
•
Others include ______,________,_______

A

Lincomycin and clindamycin

cephalosporins, ampicillin, tetracycline

31
Q

Pathogenesis Of pseudomembrane colitis:
Leads to

_________ of C.difficile

Intra-abdominal __________

_________ of mucosal lining ______ of fluid

_______ of colonic mucosa

____________ and ___________

A

Overgrowth

production of toxins

Inflammation

Outpouring

Necrosis

Fibrinous exudate and pseudomembrane Bloody diarrhoea.

32
Q

Clinical presentation of C.difficile
infections

A spectrum of disease
• Antibiotic associated ________

Antibiotic associated _____

______________________

A

diarrhoea

colitis

Pseudomembranous colitis

33
Q

Clinical presentation of C.difficile
infections

A spectrum of disease
• Antibiotic associated diarrhoea _________%

Antibiotic associated colitis _______%

Pseudomembranous colitis _________%

A

15 –25

25-50

greater than 95

34
Q

Clinical presentation of C.difficile
infections

All ages may be affected but primarily a disease of the ________ and ___________

Children appear to be ________ to the disease through carriage is highest in children under ______.

A

elderly and debilitated.

refractory

2yrs

35
Q

Pseudomembranous colitis

Most cases are ________ acquired

A

hospital

36
Q

Pseudomembranous colitis

Community-acquired C. difficile

Reported in people with no known risk factors, including people with no recent health care contact or use of antibiotics.
Often due to _________ of C. difficile that _____________

A

an aggressive strain

produces far more toxins than other strains do.

37
Q

Pseudomembranous colitis

Complications
_________
______ failure
Perforation
Toxic ————-
Death

A

Dehydration

Renal

megacolon

38
Q

Prevention of C.dificile

Avoid ________ antibiotic use
Wash your hands with soap and warm water

Contact precautions:_____ patients and wear disposable gloves and isolation gowns while in the room until at least _________ after diarrhoea stops

Good environmental cleaning
All surfaces should be carefully washed and disinfected with a product that contains _________

A

unnecessary

Isolate

48 hours

chlorine bleach

39
Q

If you don’t keep raw foods—such as beef, poultry, seafood, and eggs—separate from other foods, microbes from the raw foods can spread to other foods

T/F

A

T

40
Q

Microbes can also spread from raw foods to your hands, kitchen utensils, cutting boards, and kitchen surfaces during food preparation

T/F

A

T

41
Q

If you don’t wash your hands, utensils, cutting boards, and surfaces completely after they have come into contact with raw foods, they can spread microbes to other foods

T/F

A

T

42
Q

Infections with microbes—viruses, bacteria, and parasites—cause most food poisoning

T/F

A

T

43
Q

Harmful chemicals also cause some cases of food poisoning

T/F

A

T

44
Q

Common symptoms of food poisoning include

______ or _______

______

______ in your abdomen
______

headache

Symptoms range from mild to severe and may last from a few hours to several days.

A

diarrhea or bloody diarrhea

vomiting
pain in your abdomen
fever

45
Q

Less commonly, some types of food poisoning—such as ________, ________ poisoning —can affect
your ________ system and Symptoms may include

________

________

________

________

________

A

botulism

fish and shellfish poisoning

Nervous

blurred vision
headache
paralysis
tingling or numbness of your skin weakness

46
Q

Many types of bacteria can cause food poisoning, including certain species of

________

certain types of _______

certain species of __________

_________

______________

certain species of _____

Listeria _________

A

Salmonella

certain types of Clostridium

certain species of Campylobacter

Staphylococcus aureus

Escherichia coli

certain species of Vibrio

Listeria monocytogenes

47
Q

Many types of bacteria can cause food poisoning, including certain species of

Salmonella – _______

certain types of Clostridium, including the common _________ and the less common _________, which causes an illness called _______

certain species of Campylobacter, including __________

Staphylococcus aureus
Escherichia coli
certain species of Vibrio
Listeria monocytogenes

A

non-typhi

C. perfringens

C. botulinum; botulism

C. jejuni

48
Q

The pathogenesis of foodborne gastroenteritis can be broken down into 3 main mechanisms, namely:

Pathogens that _____________ ______ it is consumed (________ toxin)

Pathogens that make a toxin ___________ _____ the food is ingested

Pathogens that _________________ and ___________, releasing factors that cause an inflammatory diarrhea.

A

make a toxin in the food before ; preformed

in the gastrointestinal tract, after

invade the bowel wall and directly break down the epithelial lining

49
Q

Pathogenesis Of food poisoning

Enterotoxins productions: (eg, _________, _________ strains of E. coli)

They adhere to ________________

These toxins ____________ and cause _________ and ________ by stimulating adenylate cyclase, resulting in _________

_________ produces a similar toxin

A

Vibrio cholerae; enterotoxigenic

intestinal mucosa without invasion

impair intestinal absorption

secretion of electrolytes and water

watery diarrhea

C. difficile

50
Q

Pathogenesis Of food poisoning

Exotoxins are produced by some organisms (eg, ________,_______,________)

The exotoxin can cause gastroenteritis without ________

These toxins generally cause (acute or chronic?) nausea, vomiting, and diarrhea within ______ of ingestion of contaminated food

Symptoms abate within ________

A

Staphylococcus aureus, Bacillus cereus, Clostridium perfringens)

bacterial infection

Acute ; 12 hours; 36 hours.

51
Q

Pathogenesis of food poisoning

Mucosal invasion occurs with some organisms (eg, _______,________, _______, ________, some E.
coli subtypes) that invade the mucosa of the small bowel or colon and cause _________,________, exudation of ______- rich fluid, and secretion of electrolytes and water

The invasive process and its results can occur ————————-

The resulting diarrhea has evidence of this _____ and ________ with ______ and _____ present on microscopy and sometimes with gross blood.

A

Shigella, Salmonella, Campylobacter, C. difficile

ulceration, bleeding

protein

whether or not the organism produces an enterotoxin

invasion and inflammation

WBCs and RBCs

52
Q

Preformed toxins

________ and _______ produce heat-stable enterotoxins in the food before it is consumed

Transmission: These pathogens are usually transmitted by a food handler and often found in summer picnic foods

S aureus: grows well in __________________

Bacillus cereus: grows in _____ foods, such as _____, but is also found in _____, pork, and vegetables

Incubation period: ______. Ingestion of preformed toxins leads to (slow or rapid?) onset of symptoms.

A

Staphylococcus aureus and Bacillus cereus

Dairy, meat, eggs, and salads

starchy;rice; beef; 1–6 hours; rapid

53
Q

Preformed toxins

These bacteria usually affect the __________, causing nausea, profuse vomiting, and abdominal pain/cramping.

The emetic enterotoxin can be found in __________ and the __________. Testing is rarely conducted, however, because illnesses are __________

There is ______ risk of person-to-person spread

Symptoms- (Gradual or Sudden?) onset of nausea and vomiting after eating suggests ingestion of a preformed toxin

A

small intestine; vomitus

food; self-limited

no

Sudden m

54
Q

Preformed toxins

Diagnosis is usually made based on _________ and ________

Treatment -

No antibiotics needed because it is a _________ _________

_________ care and _________ antiemetics help control vomiting.

Prognosis: _________ _________ recovery in _________ is typical

A

history and food diary

preformed enterotoxin

Supportive ; parenteral

Rapid spontaneous ; 1 day

55
Q

Pathogens that transmit illness by making a toxin after consumption C perfringens

Transmission: ingestion of __________ that have germinated in food products, such as beef, pork, home canned foods, and poultry1

Pathophysiology: Once spores reach the __________ , they produce __________, leading to __________ diarrhea.

Incubation: __________

Symptoms: frequent __________ and abdominal cramping; rarely, fever, nausea, and vomiting

A

spores

small intestine; enterotoxin; watery diarrhea

6–48 hours; watery stools

56
Q

Pathogens that transmit illness by making a toxin after consumption C perfringens

Duration: usually ___________

Treatment: Rarely does a patient need _____________. Antibiotics are of ____ given the ______________________ in the short lived nature of this illness, but fecal _________ are present because this is an __________ gastroenteritis.

A

less than 24 hours

intravenous fluids

no use

short duration of symptoms

leukocytes ;inflammatory
.

57
Q

Pathogens that transmit illness by making a toxin after consumption C perfringens

Prognosis: _________ , rarely lasting more than _________. Ingestion of _________ strain of these bacteria, however, can lead to a serious illness, _________(_________).
Symptoms include severe abdominal pain, vomiting, diarrhea, and possible _________ and can be rapidly fatal.

Prevention: Do not _________ that have already been cooked warm for long periods of time.

A

Self-limited ; 24 hours; type C

enteritis necroticans (pigbel)

shock; keep foods

House Microbiology (93 decks)

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