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DU PA Infectious Dia

DU PA Infectious Diarrhea

diarrhea that lasts less than 14 days acute diarrhea
duration is between 14-30 days persistent diarrhea
diarrhea that lasts more than a month chronic diarrhea
most diarrheal illnesses are __ self limiting and last less than one day
increased pulse rate when about __% of intravascular volume is lost 10
painful evacuation of the bowels tenesmus
avoid __ products with diarrhea milk (lactose)
what is the BRAT diet bananas, rice, applesauce, toast
only order stool studies if diarrhea is persistent or recurring, there is history of fever or tenesmus
fecal leukocytes tests for inflammatory diarrhea
diagnostic yield of stool cultures 1.5-5.6%
enteropathogens tracked by CDC e. coli, Salmonella, Shigella, Yersinia, Vibrio, Listeria, Cyclospora, Campylobacter, Cryptosporidium
MESSY CACA stands for Medical disease, E. coli, Shigella, Salmonella, Yersinia, Campylobacter, Amoba (entamoeba histolitica), C. difficile, Aeromonas
most diarrhea in the US occurs in winter
familial outbreaks, nursing homes, cruise ships norovirus
associated transmission with water transmission (contaminated streams, day care centers) giardia
foul-smelling water diarrhea, cramps, and flatulence from this cyst forming flagellate protozoa giardia
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
protozoa in the immunocompromised cyclospora, isospora, cryptosporidium, microsporidia
small gram neg rods, watery diarrhea, associated with seafood-particularly raw oysters vibrio cholera
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
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
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
E. coli __, hemorrhagic colitis, severe abdominal pain, bloody diarrhea, associated with undercooked beef, unpasturized juices (apple cider) O157:H7
__ can cause hemolytic uremic syndrome, acute renal failure, thrombocytopenia, microangiopathic hemolytic anemia E. coli O157:H7
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
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
diarrhea, fever, abdominal pain for 1-2 weeks, chronic form can last for months. terminal ileum affected and can present as appendicitis Yersinia
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
most common cause of nosocomial diarrhea, gram positive spore forming rods, must use soap and water to clean clostridium difficile
usually entero-toxigenic E. coli traveler's diarrhea
opiate without systemic effects, inhibits peristalsis, can be used with antibiotics for traveler's diarrhea loperamide
do not use __ in patients with shigella, C. difficile, E. coli O157 anti-motility agents
world wide, acute diarrheal illness are the most common cause of __ death in childhood
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
those with decreased __ are at increased risk of acute diarrheal disease gastric acidity
example of an acide resistant pathogenic microorganism shigella
example of pathogenic microorganisms that colonize the small bowel Vibrio cholera, Esherichia coli
example of pathogenic microorganisms that invade the mucosa of the small bowel Rotavirus, Norovirus
__ of the small bowel deters colonization of most organisms peristalsis
__ facilitate adherence of successful colonists to mucosal surfaces fimbria, lectins
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
patients infected with __ pathogens seldom have fever or other major systemic symptoms, and little or no inflammatory response occurs secretory toxin producing pathogens
after ingestion of a large inoculum, __ colonized but do not invade the small bowel secretory toxin producing pathogens
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
with secretory toxin producing pathogens rapid loss of diarrheal fluid results in __ saline depletion, base deficit acidosis, and potassium deficiency
__ can cause massive intestinal fluid losses sometimes exceeding 1 L/hr in adults V. cholera, and E. coli
in the absence of antibiotics __ runs its course in 2-7 days, during which fluid and electrolyte repletion is critical V. cholera diarrhea
secretory toxin producing pathogens V. cholera, and E. coli
__ are soluble factors that directly destroy mucosal epithelial cells cytotoxins
__ are cytotoxin producing pathogens Shigella dysenteriae, enterohemorrhagic E. coli, Clostridium perfringens, and Vibrio parahaemolyticus
Toxin induced diarrhea caused by __ has a short incubation period and a brief duration (<36 hours) C. perfringens
__ 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
some toxins are ingested directly in food as with __ food poisoning S. aureus, B. cereus
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)
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
__ is associated with contaminated rice B. cereus
__ are less prominent in food poisoning syndromes with longer incubation times nausea and vomiting
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
invasive microorganisms often induce a significant inflammatory response, as a result the stool contains __ pus cells, large amounts of protein, and often gross blood
__ rarely occurs with invasive diarrhea (except in children) significant dehydration
out breaks in child care centers or custodial institutions, person to person transmission shigella
zoonosis, survives desiccation in processed foods nontyphoidal salmonella
zoonosis, worldwide distribution, transmitted in dairy products Campylobacter jejuni
zoonosis, occasionally transmitted in dairy products Yersinia enterolitica
coastal salt waters, transmitted by inadequately cooked shrimp and shellfish Vibrio parahaemolyticus
almost always follows antimicrobial therapy Clostridium difficile
outbreaks among children, world wide distribution, unusual and mild in adults Rotavirus
microepidemic patterns, no specific age predilection Norovirus
person to person transmission, very rare in the US, Canada, Western Europe Entamoeba histolytica
relatively resistant to gastric acid only 10-100 microorganisms are needed to cause illness shigella
direct person to person transmission is more common with __ than it is with other bacterial enteric infections shigellosis
the organism initially multiplies int he small intestine, producing watery, noninflammatory diarrhea. later it invades the colonic epithelium, causing the characterisitic bloody stools shigella
unlike salmonella, shigella rarely causes bacteremia
shigellosis usually resolves in __ days 3-6
usually results from ingestion of contaminated meat, dairy, or poultry products salmonella
unlike shigella, salmonella is remarkably resistant to __ dessication
salmonella usually causes an illness lasting __ days characterized by fever, nausea, vomiting, and diarrhea 2-3
__ may be responsible for up to one third of acute febrile diarrheal illnesses in North America Campylobacter jejuni
__ 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
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
EHEC outbreaks are most commonly associated with __ ingestion of undercooked hamburger
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
infections with rotovirus and norovirus will cause mild to moderate cramping ab pain. stool is usually watery, and seems noninvasive, with few inflammatory cells
north america, rocky mountain water sources are frequent origins of __ microepidemics. Ingestion of only a few organisms are required for illness Giardia lamblia
diagnosis of giardia lamblia may be made by __ identifying the organism in stool or duodenal mucus or by small bowel biopsy
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
Created by: bwyche