Schoenwald - GI Infections Flashcards by Alice Richards

acute infectious diarrhea lasts <

2 weeks

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community outbreaks of infectious diarrhea suggest what source (2)

viral

food

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__ hx is important in infectious diarrhea

travel

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2 characteristics of noninflammatory diarrhea

watery

non bloody

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noninflammatory has no __ invasion

and no __ on smear

tissue

fecal leukocytes

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anti motility agents are ok to use in which type of infectious diarrhea

noninflammatory

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pathogens associated w. non inflammatory infectious diarrhea

staph

bacillus cereus

listeria

enterotoxigenic e.coli

vibrio cholera

norovirus

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inflammatory infectious diarrhea is differentiated from non-inflammatory by

inflammatory diarrhea: colonic tissue invasion by organism or toxin

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inflammatory infectious diarrhea mc affects

lower colon

LLQ

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2 common sx in inflammatory infectious diarrhea

fever

bloody diarrhea

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__ will be present on smear with infectious inflammatory diarrhea

fecal leukocytes

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if diarrhea lasts > __ days,

you should consider __,

except in the case of __

non infectious cause

cdiff

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do NOT use __ in the tx of inflammatory infectious diarrhea

anti motility agents

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pathogens associated w. cytotoxin production in infectious inflammatory diarrhea (2)

E.coli 0157:H7

Cdiff

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pathogens associated w. mucosal invasions in infectious inflammatory diarrhea (3)

campylobacter

shigella

salmonella

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virus associated w. infectious inflammatory diarrhea

cytomegalovirus

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parasite associated w. inflammatory infectious diarrhea

entamoeba histolytica

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mc symptom associated w. c.diff infxn

copious watery diarrhea → ex 15-30 bm/day

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possible other sx of cdiff infxn (besides watery diarrhea)

abd pain/cramps

low grade fever

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2 intestinal complications of cdiff infxn

toxic megalocolon

colectomy

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rf for cdiff infxn (4)

previous abx

advanced age

previous hospitalization

nursing home resident

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what abx are associated w. cdiff infxn

clindamycin

penicilins

cephalosporins

fluoroquinolones

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cdiff infxn definition

3 or more unformed stools over 24 hr x 2 consecutive days

in conjunction w. positive stools for pseudomembranes

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incidence of cdiff has __ from 2000-2005

tripled

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3 serology findings used in cdiff dx

leukocytosis → **bandemia** hypoalbuminemia (+) stool test

3 tests used for cdiff

PCR antigen detection toxin testing

\_\_ test used for cdiff is highly sensitive and specific and can be (+) in asymptomatic pt

PCR

\_\_ test for cdiff is nonspecific

antigen detection

which cdiff test has high rates of false negatives

toxin testing (A and B)

cdiff tx

***know dosing for this***

tx for initial episode of mild/mod cdiff w. leukocytosis \<15,000, creat \< 1.5

vanco 125 mg po qid x 10 days OR fidaxamin 200 mg po qid x 10 days

tx for initial episode of severe cdiff w. leukocytosis \>15000 and creat \> 1.5

vancomycin 125 mg po qid x 10 days OR fidaxamin 200 mg po bid x 10 days

tx for initial episode of complicated cdiff

vanco 500 mg po qid OR via NG tube AND/OR metronidazole 500-750 mg IV q 8 hr

complicated cdiff clinical parameters (3)

hypotn or shock perforation megacolon

tx for 1st recurrence of cdiff

vanco oral taper OR fidaxamin

tx for 2nd recurrence of cdiff

vanco oral taper OR fidaximin fecal microbiota transplant

oral vanco is only used for

cdiff

how do you oral taper vanco

125 mg qid x 1-2 weeks → then start tapering down to tid → then bid → then qd → then stop

prevention for cdiff (3)

abx stewardship environmental control/hand washing chlorine based disinfectants

cdiff spores can live up to __ months on surfaces and __ are an important vector

5 health care workers

\_\_ are ineffective for cdiff prevention

etoh hand preps → ***must be soap and water***

most effective surface disinfectant for cdiff

chlorine based

salmonella enteriditis bacteria classification

gram neg rod

source of salmonella enteriditis infxn (2)

meat/eggs food handlers

what is a long term carrier of salmonella

pt can be culture (+) for 1 month post tx

mc symptoms in salmonella infxn

fever diarrhea

what sx is uncommon w. salmonella infxn

bloody stools

salmonella commonly spreads to __ in bacteremic pt's (4)

vascular grafts joints kidneys liver

salmonella is usually self limiting if not, tx for complicated cases (2)

1. cipro 2. bactrim

typhoid is a __ type of fever

salmonella

typhoid fever may be asymptomatic, if not sx may include (6)

diarrhea constipation skin rash on torso/back fever abd pain weakness

high risk countries for typhoid fever (4)

india pakistan caribbean mexico

how is typhoid fever spread (3)

contaminated foods sewage food handlers

t/f typhoid fever is resistant to abx

abx tx for mild typhoid fever

azithromycin

tx for severe typhoid fever

carbapebems → ***esp w. travel hx***

in the US, what GI infxn is associated w. daycares

shigella

shigella has __ spread and the mc symptom is \_\_

fecal/oral secretory diarrhea

shigella infxn is also called

dysentery

4 characteristics of secretory diarrhea associated w. shigella

bloody watery pus mucus

bacteria classification of shigella

gram negative rod

tx for shigella

1. cipro 2. bactrim or azithromycin → *high resistance*

what GI infxn has associations w. guillain barre and reactive arthritis

campylobacter

campylobacter is the #1 cause of __ in the US

food borne illness

bacteria classification of campylobacter

gram negative rod

campylobacter infxn is associated with what foods

sausages/hard meats undercooked chicken

prodrome sx of campylobacter (7)

**low grade sx:** HA fever myalgia malaise abd pain diarrhea fever

tx for campylobacter

1. cipro 2. azithromycin

main cause of HUS in US

Enterohemorrhagic shiga toxin 0157 (e.coli 0157)

80% of travelers diarrhea is caused by

enterotoxigenic e.coli (not the same as 0157)

sources of e.coli 0157 (4)

undercooked ground beef unpasteurized juice milk working w. cattle

sx of e.coli infxn (3)

bloody diarrhea severe cramping n/v

\_\_ is uncommon in ecoli infxn

fever

HUS is severe and can be fatal in (2)

kids elderly

hemolytic anemia leads to (2)

thrombocytopenia acute renal insufficiency

what factor differentiates TTP from HUS

ADAMTS 13 will be (+) in TTP

common lab findings in HUS

anemia decreased haptoglobin increased creatinine thrombocytopenia hematuria, proteinuria negative coombs

tx for HUS is \_\_ and __ are not very effective

supportive abx

protozoa related to non inflammatory diarrheas

giardia amoeba

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brainscape wouldn't let me delete it?

why is this card here??

brainscape wouldn't let me delete it :(

staph food poisoning is from \_\_, not the bacteria

toxin

cardinal sign of staph food poisoning

rapid onset → 4-6 hr *other: cramping, diarrhea, n/v*

foods associated w. staph food poisoning

high salt high sugar *ex potato salad at cook out*

tx for staph food poisoning

self limiting no abx

what foodborne infection is associated w. unpasteurized dairy and is esp dangerous for pregnant women and immunecompromised

listeria monocytogenes

listeria can lead to (2)

bacteremia meningitis

\_\_ use is a predisposing factor for listeria monocytogenes

corticosteroid use

tx for listeria

ampicillin

why is ampicillin effective for listeria

crosses bbb for meningitis

main cause of travelers diarrhea

enterotoxigenic e.coli

less severe form of e.coli 0157

enterotoxigenic e.coli

2 sx of enterotoxigenic e.coli

profuse non bloody diarrhea cramping

dx for enterotoxigenic e.coli (2)

stool culture OR PCR

3 possible tx for enterotoxigenic e.coli

cipro 500 mg po bid x 5-7 days OR bactrim 180/800 mg po bid x 7 days OR azithromycin

what GI infxn is characterized by massive secretion from small bowel of profuse watery diarrhea (up to 20 L/day)

vibrio cholera

cholera is spread through __ (2) and has a __ hr onset

poor water sanitation shellfish 12-72 hr

what do you think when you see “rice water stools”

cholera

\_\_ is rare in cholera

fever

tx for cholera (2)

**early and continuous fluid resuscitation** doxycycline OR cipro → can limit but dehydration is main issue

viral gastroenteritis has a __ onset

rapid

mc of gastroenteritis

norovirus

t/f norovirus gastroenteritis is no longer contagious after symptoms resolve

sx of norovirus

sudden onset vomiting/diarrhea abd cramping

norovirus lasts _ days

1-3

norovirus outbreaks are associated with __ settings

community

gold standard test for norovirus

culture *PCR now available too*

tx for norovirus

self limiting

guidelines for food handlers post norovirus infxn

stay away from work 48-72 hr