UW GI diarrhea 2 algorithms 04-02 (2)

Question 1

Acute infectious diarrhea.
High risk features: bloody stools or high grade fever; severe disease (eg hospitalized); elderly, immunocompromised; diarrhea >7d. -> NO?

Answer 1

Supportive care only (ie fluid replacement)

Question 2

Acute infectious diarrhea.

High risk features: bloody stools or high grade fever; severe disease (eg hospitalized); elderly, immunocompromised; diarrhea >7d. -> YES -> ?

Answer 2

stool studies*:
-fecal leukocytes
-multiplex PCR testing
-Stool culture

*Consider ova and parasite testing for recent travel and/or Cl. difficile assay for recent antibiotic/hospitalization

Question 3

Acute infectious diarrhea.
High-risk features -> Stool studies –> NONINFLAMMATORY DIARRHEA ->?

Answer 3

Consider antibiotics for:
- severe disease
- elderly and immunocompromised
- pathogens with low infectious dose (eg Shigella)

Question 4

Acute infectious diarrhea.
High-risk features -> Stool studies –> INFLAMMATORY DIARRHEA: bloody stools; (+) fecal leukocytes) -> STEC (via PCR) ->?

Answer 4

avoid antibiotics due to HUS risk

IV volume expansion

Question 5

Acute infectious diarrhea.
High-risk features -> Stool studies –> INFLAMMATORY DIARRHEA: bloody stools; (+) fecal leukocytes) -> NON-STEC ->?

Answer 5

same as noninflammatory diarrhea.

Consider antibiotics for:
- severe disease
- elderly and immunocompromised
- pathogens with low infectious dose (eg Shigella)

Question 6

Acute infectious diarrhea.
STEC - Shiga toxin-producing E.coli

Answer 6

.

Question 7

Foodborne disease. Vomiting predominant? 2

Answer 7

S aureus
Bacillus cereus

Question 8

Foodborne disease. Noninflammatory (aka watery stools are typical), mos? 7

Answer 8

Viruses (noro, rota)
Clostr. perfringens
ETEC
Vibrio cholerae
Listeria
Parasite (giardia, cryptosporidum, cyclospora)
Intestinal tapeworm

Question 9

Foodborne disease. Inflammatory (aka blood/mucoid stools or positive fecal leu and/or RBC), mos? 6

Answer 9

STEC
Shigella
Campylobacter
Salmonella
Vibrio parahaemolyticus
Yersinia

Question 10

Foodborne disease. Extraintestinal symptoms, mos? 4

Answer 10

Clostr. botulinum (descending paralysis)
Listeria (meningitis)
Vibrio vulnificus (cellulitis, sepsis)
HAV (jaundice)