Week 4/5 - A - Gastroenteritis (C.Diff, rotavirus (children), norovirus (winter vomiting)), peritonitis/intra-abdo sepsis/sepsis Flashcards
Define colonisation? Define pathogen? What is virulence?
Colonisation is the establishment of a microorganism on or within a host without inflammation A pathogen is any microorganism that has the potential to cause disease Virulence is the degree of pathogenicity - the likelihood of a pathogen causing disease
Define infection? Define bactaraemia? (septicaemia term no longer used) Define sepsis? What can this lead to?
Infection Inflammation due to a microbe Bacteraemia The presence of viable bacteria in the blood Sepsis is an overwhelming and life-threatening inflammatory response to a severe infection * It can lead to tissue damage, and organ failure –> Septic shock * and eventually death
* Can classify bacterial organisms as gram positive/negative * Can classify based on shape * Clan classify based on growth characteristic - aerobic or anaerobic What are the different shapes? - give an example
Bacilli - gram negative bacilli eg enterobacteriaceae - includes the coliforms Coccus - gram positive cocci eg streptococci (chains) / staphylococci (clusters) Gram negative (diplo)cocci - eg neisseria meningitidis / gonorrhoea Spirochete - gram negative spirochete eg helicobacter pylori
What is the normal bacteria flora of the mouth?
Examples of normal flora of mouth Strep viridans (alpha haemolytic strep) Neisseria sp (gram negative diplococci) Candida
What are examples of normal flora of stomach/duodenum?
Stomach/duodenum is usually sterile as it has a low pH Few candida and staphylococci and lactobacillia may survive
What is the normal flow of the jejunum? What is the normal flow of the colon?
Jejunum - small numbers of coliforms and anaerobes Colon (faecal flora) 0 large numbers of coliforms, anaerobes (clostridium species), enterococcus faecalis
What is an aerobic bacteria? What is a strict aerobe? (give an example?
Aerobic organismms - Organisms that grow better with oxygen, but can also grow without it, e.g. staphylococci, streptococci, enterococci and coliforms (i.e.the majority of human pathogens) Strict aerobe - organisms that require oxygen for growth * eg pseudomonas or legionella * (both gram negative strict aerobic bacilla)
What is a strict anaerobic bacteria? Give an example of a gram positive and gram negative species of anaerobic bacteria and wher they are present?
* A strict anaerobic bacteria is one that will not grow in the presence of oxygen - they are presen in large numbers in the large bowel Gram positive anaerobic bacilli * Clostridium species * Tetani - tetanus * Perfringes - gas gangreen * Difficle - antibiotic associated colitis * Botulinum - botullism Gram negative aenarobic bacilli - Bacteroides
What are the different common things that increase the risk of GI infections in the community?
Cross contamination work surfaces/utensils Undercooking (insufficient heat to kill of pathogens), linked to inadequate defrosting of frozen food Improper storage of food (inadequate refrigeration) Poor reheating of food
When is a patient with a GI infection most infectious? If a staff member develops diarrhoea, how long should you stay off work?
patients at their most infectious when symptomatic with diarrhoea If you develop diarrhoea that is probably infectious, STAY OFF WORK until 48 hours after symptoms have stopped (special leave)
What is the most common healthcare-associated diarrhea? - also known as antibiotic associated colitis Is it part of the normal colonic flora?
Clostridium difficile (C. Diff) is the most common healthcare associated diarrhoea It is carried as part of the normal colonic flora in partiular in elderly and infants
When does clostridium difficile infection develop? What is the mechanism of the disease?
Clostridium difficile infection develops when antibiotics that are prescribed kill off or suppres the normal competitive gut flora which allows C diff to overgow The organsims produces 2 exotoxins - toxin A (enterotoxin- toxic to the bowel) and toxin B (cytotoxin - toxic to other cells) These toxins cause colitis. C diff also produces spores which are more resistant to disinfectants and allows transfer of organism from one patient to another
What type of bacteria is C.diff? What drugs cause an increased risk of C.difficile infection?
C.diff is a gram positive anaerobic bacilli 4C antibiotics * Clindamycin * Co-amoxiclav (amoxicillin + clavulanic acid) * Ciprofloxacin - and other quinolones * Cephalosporins Also PPIs increase the risk Also enteral feeds increase the risk
What are the symptoms of a C.diff infection? What may be seen on endoscopy in severe cases?
Watery diarrhoea - sometimes bloody Abdominal pain Raised white cell count Severe cases may cause pseudomembranous colitis - viscious collection of inflammatory cells, fibrin cells and necrotic cells
There is no one good lab test for C.diff How is it diagnosed?
Screening test - stool immunoassay for glutamate dehydrogenase (common antigen indicating presence of the organism) If GDH positive, then need to test for presence of toxin (Toxin A&B) Stool toxin test (toxin immunoassay, toxin PCR) - confirms infection from colonoisation
What can severe cases of C.difficile cause to the bowel?
* Ileus * Colonic dilatation >6cm on AXR/CT, * Toxic megacolon (colon to expand, dilate, and distend. When this happens, the colon is unable to remove gas or feces from the body. If gas and feces build up in the colon, your large intestine may eventually rupture) and * /or pseudomembranous colitis