Summarizing Case: Enteric Disease Flashcards
Shigella
daycare exposure, 1-4d incubation
dx stool culture
S. Aureus
rapid onset, nausea/ vomiting, food contamination, 1-6hr incubation
testing of food for toxin required, rarely done unless in a commercial setting
Campylobacter jejuni
poultry, eggs, puppy exposure, 2-5d incubation
dx. stool culture
E coli
day care, ground beef, contaminated water, 1-3d incubation
dx. stool culture, serotype may be necessary
Salmonella
eggs, poultry, turtle, foul smelling feces, 1-3d incubation
dx: culture
supportive unless severe infection- tx. with cephalosporin
Norovirus
very common, most common if vaccinated, accompanied by vomiting, 1-3d incubation
lack of evidence of protozoa or bacteria
tx supportive care
Rotavirus
age- young boys, season- winter; 1-3d incubation
Other viruses: Astro, corona, aden, hepatitis
Aden 8-10d incubation
Hep A, history of close contact, 2-6 week incubation; presence of urobiligin (dark urine and colic stool) confirmed by serology/PCR
Giardia
daycare, malodorous stool with lots of flatulence, travel (esp. Russia) incubation 1-4 weeks incubation
dx: stool exam, culture
dx: direct stool antigen test and stool examination
tx. with tinidazole or nitazoxanide, or metronidazole; paromocycin in pregnancy
Cryptosporidium
daycare, 1 week incubation
dx: stool exam, some direct stool antigen tests (better)
Identify and discuss the biggest problems in determining actual prevalence (or incidence) of diarrheal illnesses in any given population.
frequency of examination by a physician: most cases are never seen by a doctor much less lab-confirmed
economics and timelines of lab confirmation
non-infectious causes of diarrhea are probably a bigger issue than generally suspected
viral diarrhea is often difficult to diagnose
Identify and discuss what can be done to help decrease the incidence of GI disease in each of the following situationL daycare centers, families, immunocompromised populations, travelers and the general community.
Daycare: better personnel training, isolating changing site, smaller day care centers, use of gloves, disinfection of toys, more sinks and better hand hygiene
family: ed of parents, importance of diaper disposal, hand hygiene, care in food prep, frequent cleaning of toilet, thorough cooking of hamburger, eggs, poultry
immunocompromised: limited access to certain pets and livestock, avoid close contact with people with GI symptoms, ed regarding risks, filter water
travelers: bottled beverages, avoid salads, uncooked vegetables, rare meat, ice cubes, street food vendors, don’t brush teeth or wash face with suspect water, immunize Hep A and typhoid, self directed abs therapy: imodium w/o sign of dysentery
general community: promote hand hygiene, don’t drink untreated surface water, well-cooked hamburgers, caution with sick pets and young animals, curtail livestock use of antibiotics
Describe the pathogenesis of E. coli O157: H7 and how it is treated and prevented.
EHEC requires only a small inocoulum, and is highly acid-resistant, passed through contaminated food and water
EHEC produces a Shiga-like toxin or verotoxin which inhibits protein synthesis resulting in cell death in large intestine
leads to severe abdominal cramps, initial watery diarrhea followed by grossly bloody diarrhea (hemolytic colitis); HUS
Clostridium difficile
history of antibiotic use
toxin testing is expensive
Listeria
pregnant women, can cause flu like syndrome or meningitis, unpasteurized milk
dx culture stool or CSF
