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GI- Week 5 > Zimmer: Other bacterial gastroenteritis > Flashcards

Zimmer: Other bacterial gastroenteritis Flashcards

1
Q

What is shigella spp?

A

very closely realted to e. coli

invasive

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2
Q

Shigella sonnei

A

most shigella caused GI illnesses

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3
Q

Shigella flexnori

A

causes bacillary dysentery

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4
Q

Shigela dysenteriae

A

rarest but most severe dysentery (invasive and produces toxin)

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5
Q

How is shigella transmitted?

A

Mostly bacterium passing from stools or soiled fingers of one person to the mouth of another person (food is NOT interm)

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6
Q

What are the sxs of a shigella infection?

A

diarrhea (often bloody)
fever
stomach cramps

Symptoms start 1-2 days following exposure

Usually resolves in 5 to 7 days.

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7
Q

What is dysentery?

A

Frequent, small bowel movements with blood and mucus, accompanied by rectal pain and spasms (tenesmus)

Not a synonym for bad diarrhea!

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8
Q

What is the difference between amebic vs bacillary dysentery?

A

Amebic- gradual onset, less prostration, chronic

Bacillary/bacterial- sudden, more prostration, ACUTE + fever, chills, pus

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9
Q

Shigella spp.

A 
Bacteria
Gram (-)
Bacillus
Facultative anaerobe
nonmotile (shigella have no flagella)
Non spore forming
Mainly lactose negative,
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10
Q

How do you distinguish shigella from closely related e. coli?

A

lactose negative and non-moptile

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11
Q

How does shigella cause disease?

A 
Invades>
moves around to diff cells using mphages to travel>
mphages apoptose>
survival of bacterial>
inflammation>
sxs
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12
Q

What does shigella use to move around?

A

actin rockets

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13
Q

How do you normally tx shigella?

A

Since Shigella is invasive, if not treated it can spread beyond the GI tract and cause complications

Antibiotics for more severe cases, most usually resolve without antibiotics

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14
Q

What are possible complications of shigella?

A

HUS

*s. flexnoria can also cause reactive arthritis

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15
Q

What causes the most severe dysentery?

A

shigella dysenteriae

Invasive (phage born toxin)>
shiga toxin (verotoxin)>
toxin acts on vascular endothelial cells>
cell death

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16
Q

What diseases are caused by e. coli?

A

DUNG

Diarrhea
Urinary tract infection
Neonatal sepsis
Gram-negative sepsis

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17
Q

E. Coli

A 
Bacteria
Gram (-)
Bacillus
Facultative anaerobe
motile
Non spore forming
Mainly lactose positive
E. coli
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18
Q

What is one of the first colonizers of the GI tract at birth and is a GI commensal? What changes it from good to bad?

A

E. coli

The ability to produce a toxin

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19
Q

What is a shiga toxin producing E. coli strain?

A

STEC

Also known as VTEC or enterohemorrhagic E. coli (EHEC)

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20
Q

What causes travelers diarrhea and diarhea in children?

A

Enterotoxigenic E. coli (ETEC)

21
Q

What is the mechanism of E. coli ETEC and EHEC strains?

A

EHEC, like Shigilla toxin.

ETEC, activates adenylate cyclase, end result water into lumen, NO bacterial penetration

22
Q

What are the sxs of e. coli ETEC and EHEC strains?

A

profuse watery diarrhea and abdominal cramping>
progress to bloody diarrhea for EHEC
Fever
Nausea with or without vomiting, loss of appetite
Chills

Less common: headache, muscle aches and bloating

Incubation:
1-3 days ETEC,
3-8 for EHEC
Illness typically lasts 3-4 days, less than 10.

23
Q

What is a complication of e. coli ETEC and EHEC strains?

A

HUS

24
Q

How do you tx e. coli ETEC and EHEC strains?

A

antibiotics are NOT recommended

25
Q

How do you track outbreaks fo e. coli ETEC and EHEC strains?

A

commercial PCR and Ab based kits

26
Q

WHat are e. coli ETEC and EHEC reservoirs?

A

processed meet
unwashed veggies

(fecal oral)

27
Q

What is the primary reservoir for v. cholerae?

A

water

*Mexico, developing world

28
Q

What serogroups of v. cholerae produce cholear toxin?

A

serogroups 01 and 0139

29
Q

What is the mechanism of cholera toxin?

A

Activates adenylate cyclase
>cAMP → increased Na+ absorption, increased Cl- excretion>
Water moves into lumen>
dehydration and diarrhea

30
Q

What acute illness is characterized by rice water stools, vomiting, loss of skin elasticity and dry mucous membranes?

A

cholera

31
Q

How do you dx cholera?

A

confirmed only by isolation of the causative organism from the diarrheic stools of infected people. Less reliable methods are available for poor areas where laboratories may not be available

32
Q

How do you tx cholera?

A

antibiotic therapy may help for severe cases, rehydration therapy is really the biggest factor in treatment.

33
Q

What is the source and who are the carriers for S. typhi?

A

source- untreated water

carriers- humans

34
Q

Who is particularly vulnerable to typhoid fever caused by s. typhi?

A

travelers

*vaccine available

(drinking water, unwashed fruits and vegetables, fecal-oral contaminant)

35
Q

What Life-threatening illness begins in the GI tract and then moves to the bloodstream and can cause high fevers (103-104 °F), weakness and headache, stomach pains, loss of appetite, diarrhea or constipation
Sometimes, a rash of flat, rose-colored spots?

A

S. typhi causing TYPHOID FEVER

36
Q

What is hte danger of having a s. typhi symptomless carrier?

A

feces still contain the bacteria, and illness could reoccur

37
Q

How do you treat typhoid fever?

A

antibiotics esp to eliminate risk that pt could become carrier

38
Q

What matters most w/ diarrheal pathogens?

A

infectious dose

39
Q

What are low inoculum diarrheal pathogens?

A

Tens to hundreds of virions/cysts/bacteria will cause disease

Examples: Shigella, Giardia, Entamoeba, Norovirus

40
Q

What are high inoculum diarrheal pathogens?

A

Tens of thousands or more needed

Examples: Vibrio cholerae, C. perfringens

41
Q

What is the medium of infection for high inocuum diarrheal pathogens?

A

Medium of infection is highly contaminated: food that is contaminated then held at permissive temps; grossly contaminated water

Secondary cases rare

Example: traveler gets cholera from seafood carried to U.S. from Ecuador in luggage

42
Q

What is the medium of infection for low inoculum diarrheal pathogens?

A

Medium of infection does not need to be grossly infected, transmission through bodily contact or almost-clean water possible

Secondary cases common. Can be spread in day-care centers, families

Example: Toddler contracts Cryptosporidosis in wading pool

43
Q

What bacteria underlies most antibiotic associated diarrhea?

A

Clostridium difficile

Common in hospitalized patients or patients at care facilities

Associated with broad spectrum antibiotic use

Spread patient to patient

44
Q

C. Diff

A 
bacteria
Gram + (matchstick like)
bacilli
spore-forming
obligate anaerobe
motile
45
Q

How does c. diff cause diarrhea?

A

Exotoxins cause cell death, shallow ulcers, pseudomembranes

Early lesions superficial

May eventually invade>
Pseudomembranous colitis

46
Q

How does c. diff present?

A

Wide spectrum: asymptomatic to fulminant

Diarrhea, pseudomembranous colitis, fulminant colitis

Usually: just diarrhea

47
Q

What is the danger of fulminant diarrhea?

A

perforation

comes on suddenly and w/ great intensity

48
Q

How do you dx c. diff?

A

Stool smear

Difficult to culture b/c its an obligate anaerobe

49
Q

How do you tx c. diff?

A

Antibiotics (metronidazole, vancomycin)

Severe disease: bowel resection

New therapy: fecal transplant

GI- Week 5 (9 decks)

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