Therapeutics - Infectious Diarrhea Flashcards
4 bacterial causes of infectious diarrhea
salmonella
shigella
campylobacter
traveler’s diarrhea
2 viral causes of infectious diarrhea
norovirus
rotavirus
2 parasitic causes of infectious diarrhea
cryptosporidium, giardia
infectious diarrhea is caused by….
ingesting food/water contaminated with pathogens
(whether it’s bacteria, viruses, parasites, fungi, or protozoa)
define diarrhea
3 or more episodes of loose stool in 24 hours
define:
acute vs prolonged vs persistent vs chronic
acute - symptoms present for less than 7 days
prolonged: symptoms last 7-13 days
persistent symptoms present for 14-29 days
chronic: symptoms present for greater than 30 days
true or false
infectious diarrhea is not really a clinical concern worldwide
FALSE - IT IS
one of the leading causes of death in developing countries AND mainly affects kids and infants in poverty bc of poor sanitation
however, only 5,000 deaths in US annually
name some predisposing factors to infectious diarrhea
bad sanitation
foreign travel
immunosuppressed
day care centers
animal handlers
medications that INCREASE GASTRIC PH
true or false
infectious diarrhea caused by salmonella, campylobacter, and shigella all have similar symptoms, so we can’t distinguish the likely pathogen based on symptoms alone
TRUE
all have similar symptoms of bloody or non bloody diarrhea
most infections caused by this bacteria are associated with poultry and live stock
salmonella
infectious diarrhea caused by this bacteria is HIGHLY CONTAGIOUS and linked to outbreaks, so day care centers are at risk
shigella
infectious diarrhea caused by this bacteria is associated with undercooked poultry, meat, dairy, and contaminated water
campylobacter
how is infectious diarrhea caused by shigella so contagious and severe
bc of formation of the SHIGA TOXIN - extremely virulent
E. coli O157:H7 vs E. coli NON O157:H7
which produces the shiga toxin?
how are they each transmitted?
difference in symptoms?
causes SEVERE bloody diarrhea bc it’s enterohemmoraghic. PRODUCES SHIGA TOXIN
transmitted thru contaminated meat
non - traveler’s diarrhea. spread through FECALLY contaminated food and water. more WATERY DIARRHEA and resolves within 3 days without treatment
true or false
e. coli O157:H7 is associated with traveler’s diarrhea
FALSE
NON O157:H7 is associated with traveler’s diarrhea
presentation of viral diarrhea
watery, noninvasice of acute onset
low grade fever, headache, myalgia
self limiting and lasts less than 48 hours but may persist longer in kids, elderly, or immunocompromised
____ is the most common cause of acute diarrhea in adults
____ is the most common cause of SEVERE diarrhea in children less than 2 years old
acute diarrhea in adults = norovirus
severe diarrhea in children under 2 = rotavirus
____diarrhea is less common in the developed world.
most cases are due to ___ and ___
PARASITIC
cryptosporidium or giarda lamblia
clinical presentation of parasitic diarrhea caused by cryptosporidium vs giarda
cryptosporidium - not as bad. self limiting, watery, happens within hours of fecal-oral ingestion. however, can be severe and prolonged in immunocompromised and the elderly
giarda - presents as steatorrhea large volume (fat in stool) and weight loss occurs, occurs 7-14 days after ingestion!! usually self limiting but lasts more than 7 days a lot
rehydration is a treatment component for infectious diarrhea
explain when oral vs IV rehydration should be given
oral - to alleviate MILD dehydration
IV - moderate-severe dehydration OR mild dehydration but can’t take things PO
explain what SHOULD and SHOULD NOT be used for oral rehydration for infectious diarrhea
SHOULD - oral rehydration salts mixed with water (pedialyte). should be 1.5-2 times the volume of stool lost/day
SHOULD NOT USE - sports drinks, fruit juices, and chicken broth (NOT ENOUGH FOR REHYDRATION)
Explain what is/is not sufficient for IV rehydration from infectious diarrhea
is - CRYSTALLOIDS (lactated ringer’s, normal saline)
NOT SUFFICIENT - dextrose 5% in water
1/2 the estimated volume deficit should be replaced within the 1st 4 hours after presentation
true or false
rehydration is needed for ALL diarrhea patients
TRUE
additional treatment depends on the cause, but ALLLLL need rehydration whether oral or iv
can antimotility or antiemetic agents be used in patients with diarrhea?
they can be considered ONLY AFTER THE PATIENT HAS BEEN REHYDRATED
IT IS NOT A SUBSTITUTE FOR FLUID AND ELECTROLYTE REPLACEMENT
name an antimotility agents
loperamide
name 2 patients in which anti motility agents (loperamide) should NOT be given to
children less than 18 with acute diarrhea
patients with suspected or proven cases of toxic megacolon
overall tho, they’re not really recommended because you’re containing the bacteria/virus/parasite and not expelling it (but at the same time u also have to live lulz)
name an antiemetic agent
ondansetron
when may antiemetic agents be given in diarrhea patients
to help them tolerate the oral rehydration OR in acute gastroenteritis when the pt is vomiting
true or false
for the average, immunocompetent person, empiric antibiotic therapy is NOT recommended
TRUE
infectious diarrhea is, most of the time, SELF LIMITING
3 infectious diarrhea patients in which empiric antimicrobial therapy IS recommended
-infants less than 3 months with suspected BACTERIAL cause
-immunocompromised with severe illness
-immunocompetent ppl but they’s ILL WITH FEVER in a medical care facility or have sepsis
what is the empiric choice for bacterial infectious diarrhea
either a fluoroquinolone or azithromycin
empiric therapy for infectious diarrhea caused by:
-cryptosporidium
-giarda
both are parasites
cryptosporidium: nitazoxanide
giarda - tinidazole, nitazoxanide
alternative is metronidazole
HOWEEVER, WE USUALLY DONT TREAT - SELF LIMITING,
pt is 25 years old who retuned from haiti 2 days ago
since returning, she’s had acute onset watery diarrhea around 3-4 times a day. no other systemic symptoms
she asks for recommendation for rehydration. what is your response
PEDIALYTE
replaces both the salts and electrolytes needed for hydration
c diff infection has had increasing incidence where
in the community
1st line treatment for initial c diff infection is ___or ___
fidaxomicin or vancomycin
