Tropical Gastroenteritis

Question 1

What is the most common organism that causes acute travellers diarrhoea?

Answer 1

E.coli.

Question 2

What is the definition of travellers diarrhoea?

Answer 2

3 loose stools in 24 hours.

Question 3

What investigations would you do for acute travellers diarrhoea?

Answer 3

Stool culture/microscopy.

Question 4

What antibiotics may you give for acute travellers diarrhoea?

Answer 4

Fluoroquinolone or macrolide.

Question 5

Where does enteric fever tend to come from?

Answer 5

Indian subcontinent/SE Asia.

Question 6

What are the symptoms of enteric fever?

Answer 6

Fever, headache, constipation/diarrhoea, dry cough.

Question 7

What are the potential complications of enteric fever?

Answer 7

GI bleeding, GI perforation, encephalopathy, bone and joint infection.

Question 8

What is the antibiotic given for enteric fever?

Answer 8

IV ceftriaxone.

Question 9

What is the organism that causes amoebiasis?

Answer 9

Entamoeba histolytica (protozoa).

Question 10

What are the symptoms of amoebic dysentery?

Answer 10

Abdominal pain, fever, bloody diarrhoea/colitis, peritonism.

Question 11

What investigations would you do for amoebiasis?

Answer 11

Stool microscopy, AXR (toxic megacolon), endoscopy for biopsy.

Question 12

What is the incubation period for amoebic liver abscess?

Answer 12

8-20 weeks.

Question 13

What is the clinical presentation of amoebic liver abscess?

Answer 13

Fever/sweats, upper abdominal pain, sometimes history of GI upset (dysentery), hepatomegaly, point tenderness.

Question 14

What should you exclude before aspirating an amoebic liver abscess?

Answer 14

Hyatid disease.

Question 15

What is the management of amoebic liver abscess?

Answer 15

Metronidazole or tinidazole.

Paramomycin/diloxanide to clear gut lumen of parasites.

Question 16

What organism causes giardiasis?

Answer 16

Giardia intestinalis (flagellated protozoa).

Question 17

What is the incubation time for giardiasis?

Answer 17

Around 7 days.

Question 18

What is the clinical presentation of giardiasis?

Answer 18

Watery/malodorous diarrhoea, bloating and flatulence, abdominal cramps, weight loss.

Question 19

What investigations would you do for giardiasis?

Answer 19

Stool microscopy for cysts (or PCR), OGD for duodenal biopsy (rarely necessary).

Question 20

What is the treatment of giardiasis?

Answer 20

Metronidazole or tinidazole.

Question 21

What is the most common helminth infection in the world?

Answer 21

Ascariasis (intestinal nematodes).

Question 22

What is the life cycle of ascariasis?

Answer 22

Breaks through gut wall into venous system where it invades lungs, climbs up trachea and gets swallows again.

Question 23

Give 3 examples of flukes.

Answer 23

Schistosomiasis.

Liver flukes - clonorchis/fasciola (SE Asia).

Question 24

How does chronic schistosomiasis infection cause liver fibrosis and portal hypertension?

Answer 24

Adult worms located in portal venules.

Question 25

What is another name for tapeworms and what are they caught from?

Answer 25

Cestodes - undercooked pork and beef.

Question 26

What organism causes Chagas disease?

Answer 26

Trypanasoma cruzi (american trypanosmiasis).

Question 27

What transports the organism that causes Chagas disease?

Answer 27

The kissing bud (Triatome).

Question 28

What does Chagas disease cause?

Answer 28

Parasympathetic denervation affecting the colon or oesophagus. Can cause megaoesophagus.