DU PA Infectious Diarrhea
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| diarrhea that lasts less than 14 days | acute diarrhea
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| duration is between 14-30 days | persistent diarrhea
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| diarrhea that lasts more than a month | chronic diarrhea
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| most diarrheal illnesses are __ | self limiting and last less than one day
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| increased pulse rate when about __% of intravascular volume is lost | 10
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| painful evacuation of the bowels | tenesmus
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| avoid __ products with diarrhea | milk (lactose)
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| what is the BRAT diet | bananas, rice, applesauce, toast
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| only order stool studies if | diarrhea is persistent or recurring, there is history of fever or tenesmus
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| fecal leukocytes tests for | inflammatory diarrhea
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| diagnostic yield of stool cultures | 1.5-5.6%
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| enteropathogens tracked by CDC | e. coli, Salmonella, Shigella, Yersinia, Vibrio, Listeria, Cyclospora, Campylobacter, Cryptosporidium
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| MESSY CACA stands for | Medical disease, E. coli, Shigella, Salmonella, Yersinia, Campylobacter, Amoba (entamoeba histolitica), C. difficile, Aeromonas
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| most diarrhea in the US occurs in | winter
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| familial outbreaks, nursing homes, cruise ships | norovirus
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| associated transmission with water transmission (contaminated streams, day care centers) | giardia
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| foul-smelling water diarrhea, cramps, and flatulence from this cyst forming flagellate protozoa | giardia
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| causes necrosis of large intestine, more common in tropical and subtropical regions, abdominal pain, cramping, colitis, and bloody diarrhea. Consider in travelers and homosexual men | entamoeba histolytica
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| protozoa in the immunocompromised | cyclospora, isospora, cryptosporidium, microsporidia
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| small gram neg rods, watery diarrhea, associated with seafood-particularly raw oysters | vibrio cholera
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| abdominal pain, diarrhea and vomiting 4 hours after eating, meats, custard filled pastries, potato salad, ice-cream, contamination of food from infected skin. No more toxin production after ingestion | Staph aureus toxin ingestion
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| 1-6 hour incubation period for emetic form, longer for diarrheal illness, fried rice, meat, saucees, refrigeration prevents germination of spores, heat stabel enterotoxin causes emesis, heat labile enterotoxin causes diarrhea after an incubation period | Bacillus cereus toxin ingestion
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| symptoms 8-24 hours after eating, abdominal cramps and watery diarrhea without fever, nausea or vomiting, refrigeration of food after preparation prevents toxin formation | Clostridium perfringens toxin ingestion
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| E. coli __, hemorrhagic colitis, severe abdominal pain, bloody diarrhea, associated with undercooked beef, unpasturized juices (apple cider) | O157:H7
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| __ can cause hemolytic uremic syndrome, acute renal failure, thrombocytopenia, microangiopathic hemolytic anemia | E. coli O157:H7
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| enteric fever, bacteria pass through cells lining the small intestine and go to liver, spleen, bone marrow, 10-14 days after ingestion fever, headaches, myalgia, malaise, anorexia. 1-5% will become chronic carriers. Pulse temperature discordance | S. typhi
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| pediatric disease, tends to be associated with day care, nurseries, long-term care, need a low inoculum, lower ab cramps, diarrhea, fever, bloody, purulent stools and tenesmus | Shigella
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| diarrhea, fever, abdominal pain for 1-2 weeks, chronic form can last for months. terminal ileum affected and can present as appendicitis | Yersinia
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| Gram neg rod, damages small bowel and colon, animals are reservoirs. may have more than 10 bloody bowel movements per day, malaise, fever, ab pain. may have associated bacteremia | Campylobacter
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| most common cause of nosocomial diarrhea, gram positive spore forming rods, must use soap and water to clean | clostridium difficile
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| usually entero-toxigenic E. coli | traveler's diarrhea
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| opiate without systemic effects, inhibits peristalsis, can be used with antibiotics for traveler's diarrhea | loperamide
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| do not use __ in patients with shigella, C. difficile, E. coli O157 | anti-motility agents
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| world wide, acute diarrheal illness are the most common cause of __ | death in childhood
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| mechanisms that are normally in place to keep the jejunum and proximal ileum free of pathogenic microorganisms | low pH of stomach, rapid transit time of small bowel, antibody produced by cells in the lamina propria of the small bowel
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| those with decreased __ are at increased risk of acute diarrheal disease | gastric acidity
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| example of an acide resistant pathogenic microorganism | shigella
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| example of pathogenic microorganisms that colonize the small bowel | Vibrio cholera, Esherichia coli
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| example of pathogenic microorganisms that invade the mucosa of the small bowel | Rotavirus, Norovirus
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| __ of the small bowel deters colonization of most organisms | peristalsis
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| __ facilitate adherence of successful colonists to mucosal surfaces | fimbria, lectins
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| organisms that do not have special colonization properties pass into the terminal ileum and colon where, __ | they may compete with the naturally residing microorganisms, that produce substances that prevent intraluminal proliferation of most newly introduced bacteria
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| patients infected with __ pathogens seldom have fever or other major systemic symptoms, and little or no inflammatory response occurs | secretory toxin producing pathogens
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| after ingestion of a large inoculum, __ colonized but do not invade the small bowel | secretory toxin producing pathogens
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| secretory toxin producing pathogens produce enterotoxins that bind to mucosal cells, causing __ | hypersecretion of isotonic fluid that overwhelms the reabsorptive capacity of the colon. The diarrhea is watery and low in protein
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| with secretory toxin producing pathogens rapid loss of diarrheal fluid results in __ | saline depletion, base deficit acidosis, and potassium deficiency
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| __ can cause massive intestinal fluid losses sometimes exceeding 1 L/hr in adults | V. cholera, and E. coli
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| in the absence of antibiotics __ runs its course in 2-7 days, during which fluid and electrolyte repletion is critical | V. cholera diarrhea
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| secretory toxin producing pathogens | V. cholera, and E. coli
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| __ are soluble factors that directly destroy mucosal epithelial cells | cytotoxins
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| __ are cytotoxin producing pathogens | Shigella dysenteriae, enterohemorrhagic E. coli, Clostridium perfringens, and Vibrio parahaemolyticus
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| Toxin induced diarrhea caused by __ has a short incubation period and a brief duration (<36 hours) | C. perfringens
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| __ colonizes the colon, and in the presence of antibiotics that limits the growth of naturally occuring bacteria, produces a colitis that may have a pseudomembranous appearance | Clostridium difficile
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| some toxins are ingested directly in food as with __ food poisoning | S. aureus, B. cereus
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| distinctive features of acute food poisoning | short incubation (2-6 hours), high attack rates (up to 75% of the population at risk), and prominent vomiting (from absorbed neurotoxins acting on the CNS)
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| organisms ingested in food that produces toxins during replication in the bowel can cause food poisoning syndromes with an incubation period of __ | 8-6 hours
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| __ is associated with contaminated rice | B. cereus
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| __ are less prominent in food poisoning syndromes with longer incubation times | nausea and vomiting
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| diarrheas caused by __ are usually accompanied by fever and other systemic symptoms including headache and myalgia. Cramping ab pain, and small amounts of stool are passed at frequent intervals. | invasive pathogens
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| invasive microorganisms often induce a significant inflammatory response, as a result the stool contains __ | pus cells, large amounts of protein, and often gross blood
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| __ rarely occurs with invasive diarrhea (except in children) | significant dehydration
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| out breaks in child care centers or custodial institutions, person to person transmission | shigella
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| zoonosis, survives desiccation in processed foods | nontyphoidal salmonella
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| zoonosis, worldwide distribution, transmitted in dairy products | Campylobacter jejuni
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| zoonosis, occasionally transmitted in dairy products | Yersinia enterolitica
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| coastal salt waters, transmitted by inadequately cooked shrimp and shellfish | Vibrio parahaemolyticus
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| almost always follows antimicrobial therapy | Clostridium difficile
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| outbreaks among children, world wide distribution, unusual and mild in adults | Rotavirus
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| microepidemic patterns, no specific age predilection | Norovirus
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| person to person transmission, very rare in the US, Canada, Western Europe | Entamoeba histolytica
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| relatively resistant to gastric acid only 10-100 microorganisms are needed to cause illness | shigella
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| direct person to person transmission is more common with __ than it is with other bacterial enteric infections | shigellosis
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| the organism initially multiplies int he small intestine, producing watery, noninflammatory diarrhea. later it invades the colonic epithelium, causing the characterisitic bloody stools | shigella
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| unlike salmonella, shigella rarely causes | bacteremia
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| shigellosis usually resolves in __ days | 3-6
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| usually results from ingestion of contaminated meat, dairy, or poultry products | salmonella
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| unlike shigella, salmonella is remarkably resistant to __ | dessication
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| salmonella usually causes an illness lasting __ days characterized by fever, nausea, vomiting, and diarrhea | 2-3
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| __ may be responsible for up to one third of acute febrile diarrheal illnesses in North America | Campylobacter jejuni
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| __ produces bloody diarrhea without evidence of mucosal inflammation (grossly bloody stools with few or no leukocytes), usually with little or no fever | 0157:H7 EHEC
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| the intestinal mucosal damage from EHEC is caused by a __ which is also thought to be responsible for the hemolytic uremic syndrome | shiga-like toxin
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| EHEC outbreaks are most commonly associated with __ | ingestion of undercooked hamburger
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| both __ invade and damage villous epithelial cells, with the degree of injury ranging from modest distortion of epithelial cells to sloughing of villi | Rotavirus and Norovirus
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| infections with rotovirus and norovirus will cause | mild to moderate cramping ab pain. stool is usually watery, and seems noninvasive, with few inflammatory cells
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| north america, rocky mountain water sources are frequent origins of __ microepidemics. Ingestion of only a few organisms are required for illness | Giardia lamblia
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| diagnosis of giardia lamblia may be made by __ | identifying the organism in stool or duodenal mucus or by small bowel biopsy
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| three protozoa __ may occasionally cause self limiting acute diarrheal illness in otherwise healthy individuals, but they may cause voluminous, life-threatening diarrheal disease in the immunodeficiencies | cryptosporidium parvum, isospora belli, and cyclospora cayetanensis
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