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GI Infections
GI Infections (Traveler's Diarrhea, Food Posioning)
| Question | Answer |
|---|---|
| What are the 3 important host defenses | normal flora, gastric pH, and intestinal motility |
| What patients are at the greatest risk of GI infection | immunocompromised (HIV/AIDS, cancer, etc.), genetic determinants (type O blood increased risk of V. cholorae, Shigella, E. coli O157, and norovirus) |
| What are the 4 steps to management of GI infection | Prevention Rehydration Symptomatic Relief Antimicrobial Therapy |
| What is the cornerstone of therapy for diarrhea | Rehydration |
| What are 3 ways to prevent GI infections | personal hygiene/safe food prep (hand washing, rinse produce, do not leave foods at room temp that can spoil) improve water sanitation regulations on prep and storage of commercial food |
| When do you use Oral Rehydration Therapy and when do you useIV therapy? | ORT for mild-to-moderate diarrhea IV therapy for severe diarrhea |
| What 5 things should ORT contain | glucose, sodium, potassium, chloride, water |
| Why should you avoid soft drinks, fruit juice, broth, and sports drinks? | high osmotic content may worsen diarrhea WHO recommends reduced osmolarity solutions (Osm=245 mmol/L) |
| Which is preferable for IV therapy and why LR or NS | LR helps to correct metabolic acidosis |
| When should you avoid the use of antimotility agents (ie loperamide) | if patient has fever, bloody stools, and/or fecal leukocytes |
| When is loperamide contraindicated and why? | toxin-producing infections (EHEC, pseudomembranous colitis, shigellosis, etc.) may cause increased exposure to toxins, increasing further damage |
| What is Hemalytic Uremic Syndrome (HUS) | kidney failure due to toxin produced by EHEC |
| How is non-inflammatory and inflammatory diarrhea described | non-inflammatory: watery diarrhea inflammatory: dysenteric diarrhea (presence of blood and mucus) |
| Where do non-inflammatory and inflammatory diarrhea occur | non-inflammatory: proximal small bowel inflammatory: colon/distal small bowel |
| fecal leukocytes and lactoferrin? | non-inflammatory: FL (-), lactoferrin no to mild inflammatory: FL (+), lactoferrin elevated |
| What are the common pathogens of non-inflammatory diarrhea | Vibrio cholerae, ETEC, Clostridium perfringens, S. aureus, rotavirus, Cryptosporidium |
| What are the common pathogens of inflammatory diarrhea | Shigella, Salmonella, Campylobacter, EHEC, Listeria, C. diff |
| What is the DOC for campylobacter infection? What is 2nd line? | azithromycin Fluoroquinolones |
| What 2 pathogens usually resolve in 5-7 days and don't require antibiotics in most cases | Salmonella and Shigella |
| When are antibiotics recommended for Salmonella and Shigella | severe diarrhea, bloodstream infections, hospitalized patients |
| What pathogen is a microscopic parasite commonly transmitted by water | cryptosporidium |
| What is the difference between normal gut E. coli and EHEC | EHEC produces toxins and is transmitted through contaminated food |
| What complications are caused by the toxins produced by EHEC | bloody diarrhea, kidney failure (HUS) |
| How can transmission of EHEC be prevented | cooking foods thoroughly |
| What is the most common viral cause of gastroenteritis and what is its incubation period | rotavirus 1-3 days |
| What are 2 possible management strategies of rotavirus gastroenteritis | rehydration and probiotics |
| Other than rotavirus, what other viruses can cause gastroenteritis | norovirus, enteric adenovirus, astrovirus |
| What are the most common pathogens for Traveler's Diarrhea | EHEC, Shigella, Campylobacter, Salmonella |
| What countries are cosidered low-risk for Traveller's Diarrhea | US, Canada, Australia, NZ, Japan, Northern and Western Europe |
| What countries/areas of the world considered high-risk for Traveller's Diarrhea | Asia, Middle East, Africa (other than South Africa), Mexico, Central/South America |
| Traveler's Diarrhea classification: mild | 1-3 loose stools/dy abdominal cramps lasting <14dys |
| Traveler's Diarrhea classification: moderate | >4 loose stools/dy associated w/ dehydration |
| Traveler's Diarrhea classification: severe | any number of loose stools in the presence of fever or blood in stools |
| Bismuth Subsalicylate dosing for PREVENTION of Traveler's Diarrhea | 524 mg po QID for up to 21dys |
| Why are antibiotics not routinely recommended for prophylaxis | concern for increasing resistance false sense of security |
| What would be appropriate circumstances for antibiotics to prevent Traveler's Diarrhea | if patient is high-risk for mortality of infection (immunocompromised) or traveling to high-risk area for military mission |
| What is the most common class of antibiotics used for prophylaxis | Fluoroquinolones |
| When would you use azithromycin as prophylaxis instead of FQ's | when traveling to South and Southeast Asia due to increased FQ resistance |
| Bismuth Subsalicylate dosing for TREATMENT of Traveler's diarrhea | 525mg po q30min up to 8doses |
| What the DOC regimen for TREATING Traveler's Diarrhea | cipro 500mg po BID x3-5dys |
| WHat is the azithromycin regimen for TREATING Traveler's Diarrhea | 500mg po qd x7dys |
| What 2 antibiotics are NOT recommended for treatment and why? | Bactrim and doxycycline resistance |
| What 5 things should traveler's take with them when traveling to a high risk area | thermometer loperamide 3dys of antibiotics ORT solution salts water purification system |
| What are the six most common bacterial causes of food poisoning | campylobacter, salmonella, shigella, E. coli, yersinia, vibrio |
| What is the difference between Type A and Type C Clostridium perfringens syndromes | Type A: western countries, 24hr illness, watery diarrhea epigastric pain Type C: pork consumption in underdeveloped tropical regions, intestinal rupture, sepsis |
| What 3 bacteria can cause food poisoning where antibiotic therapy may not be effective | S. aureus, C. perfringens, B. cereus |
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