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Infectious Diarrhea

Gastroenterology

QuestionAnswer
Defn diarrhea >3/day; 200 g or ml; loose/liquid consistency
Acute/ persistent/ chronic Acute <14 days; Chronic >1 month
Chronic diarrhea: etiology Malabsorption; motility disorders; inflammation
Assessing severity of illness dehydration; duration of sx; inflammation (fever, blood, tenesmus)
Order stool studies if: Diarrhea is persistent or recurring; h/o fever or tenesmus
E. histolytica necrosis of lg intestine; tropical; abd pain, cramping, colitis; can be bloody/fevers; travelers, MSM
Vibrio watery dia, abd cramping; V para: also wound infxn; heat to >75C to destroy; susceptible: liver dz & Fe overload states
V cholera MOA activates adenylate cyclase (cAMP regulates Na & Cl absorpn/secretion)
V cholera S/S rice-water stools; poss hypotensive shock within 2 hrs; dose fx; tx rehydrate & 1 dose Cipro; untx’d 50% mortality
Pre-formed toxins: organisms S aureus; B Cereus; Clostridium Perfringens
Giardia: most susceptible immunocompromised; immunocompetent w/Ig def
Dx giardiasis with: giardia antigen stool assay
C perfringens sx Abd cramps & watery diarrhea without fever or N/V; lasts <24 hr
Invasive pathogens (most common causes of infxs diarrhea) Salmonella, shigella, campy, hemorrhagic E coli
E coli: most likely from: undercooked beef; unpasteurized juice; spinach; in warm weather
E coli: hemorrhagic colitis: severe abd pain, bloody diarrhea (no fever usually) caused by shiga or shiga-like toxin
HUS may be due to: E coli; shigella
ETEC: tx travelers diarrhea; Abx after sx onset may decrease duration; Cipro or rifaximin
Salmonella Sx fevers, myalgias, abd cramping, HA;
Salmonella complications Septicemia/Bacteremia; poss osteomyelitis, endocarditis, arthritis
Salmonella typhi Sx 10-14d post-ingestion: fever, HA, myalgia, malaise, anorexia; followed by GI sx (GB colonization & intestine reinfxn); typhoid fever: pulse-temperature discordance; 1-5% chronic carriers
Shigella Sx Lower abd cramps, diarrhea, fever, bloody, purulent stools & tenesmus; usu self-ltg (7 days)
Shigella Tx Abx recommended (FQ or Bactrim)
Yersinia Sx: Diarrhea, fever, abdominal pain for 1-2 wks (chronic: poss for mos); fx terminal ileum; lg lymph nodes (mimics appy); systemic dz: high mortality
Campy Sx: dysentery; poss bacteremia; usu self ltg (may last 1 wk/longer); assoc w/GBS & Reiters
Most common cause of nosocomial diarrhea C diff (Abx-induced diarrhea); tx w/Flagyl or oral vanco
Loperamide opiate w/o systemic fx; inhibits peristalsis; can use w/Abx for traveler’s diarrhea
DO NOT use anti-motility agents in: pts w/shigella, C diff, E coli O157 (inflammatory diarrhea)
Antimicrobial tx: used for: shigellosis, traveler’s diarrhea, C.difficile, campylobacter; can prolong salmo/C diff shedding, or worsen shiga toxin course
Tx of choice for more severe infxs diarrhea: FQ; TMP-SMX = 2nd-line tx; Add azithro for Campy
Common antibiotic causes of colitis: Ampicillin, clindamycin, tetracycline, cephalosporins
C diff mgmt: IV/PO Flagyl or PO vanco. 20% relapse in 1-2 wks after DC of therapy; relapses respond well to 2nd course of tx. Multiple relapses: consider taper & pulsed therapy
Diarrhea >3/day or 200 mL; osmotic vs secretory; dx: fecal WBC, occult blood, flex sig/bx, upper GI
Diarrhea: inflam vs non-inflammatory agents inflam: cMV, E histo, EHEC, C diff, SSC; non-inflam: noro, rota, giardia, crypto, SA, B cereus, vibrio cholera
Diarrhea: Abx for: Shigella, cholera, ETEC, C diff; No Abx for salmo, campy, EHEC, Yersinia
Oral Rehydration Solution: 3.5 g NaCl, 2.5 g Na HCO3, 1.5 g KCl, 20 g glucose, in 1L water
Traveler’s Diarrhea is caused by: E. coli (ETEC); tx is hydration & Cipro
Greasy, foul smelling, floating stools. Pear-shaped flagellated protozoan w/ 2 “eyes”. Water, travel, camping history Giardia
Afebrile, watery or loose stool. No blood or mucus Viral Gastroenteritis
Abdominal pain, diarrhea after picnic/party. Eaten ham, cream, custards, mayonnaise Staphylococcus aureus infectious diarrhea
Acute bacterial diarrhea w/ prodrome of HA, F, then crampy abd pain & diarrhea Campylobacter jejuni (most common cause of acute bacterial diarrhea)
Most important agent of gastroenteritis in infants Rotavirus A
Other agents of gastroenteritis in infants Adenovirus (serotypes 40/41); Coxsackie Virus
Most important viral agent of gastroenteritis in children/adults Calicivirus
Other viral agents of gastroenteritis in children/adults Norwalk virus; Astrovirus; Reovirus
E. coli groups = small bowel processes Enterotoxigenic; enteropathogenic; enteroaggregative
E. coli groups = colon processes (bloody diarrhea): enterohemorrhagic; enteroinvasive
AIDS-associated diarrhea 2/2: Mycobacterium avium-intracellulare (MAI)
E coli group = in developed countries Enterohemorrhagic
E coli group = more common in pediatric populations (usu developing countries) Enteropath & enteroaggregative
E coli group = most common in developing countries Enteroinvasive
Severe cases of ETEC can be treated with: SMZ/TMP or quinolone; prophylaxis not recommended
Most common cause of BACTERIAL gastroenteritis C. jejuni
Parasitic GI Syndromes in AIDS patients/protracted diarrhea: MAI, Giardia lamblia, Cryptosporidium parvum, Isospora belli
Toxin A = enterotoxin; Toxin B = cytotoxin C. diff
Parasitic GI causes of diarrheal disease G. lamblia, C. parvum, B. hominis
Intestinal amoebiasis Entamoeba histolytica
Rice-water stools; poss hypotensive shock within 2 hrs; dose effects = Vibrio cholera
HUS may be due to: E coli; shigella ETEC: tx travelers diarrhea
Shigella Sx Lower abd cramps, diarrhea, fever, bloody, purulent stools & tenesmus; usu self-ltg (7 days)
Gastroenteritis: Antimicrobial tx: used for: shigellosis, traveler’s diarrhea, C.difficile, campylobacter; can prolong salmo/C diff shedding, or worsen shiga toxin course
Vibrio cholera MOA stimulates adenyl cyclase in intestinal epithelial cells to overproduce cAMP => H2O & Cl- hypersecretion => diarrhea
salmonella: 3 patterns Enteric (typhoid) fever; gastroenteritis; bacteremia
Salmonella: Enteric (typhoid) fever S/S 5-14d incubation, insidious (kids abrupt); F, HA, ST, myalgia, malaise; abd pain, pea soup diarrhea; pulse-temperature discordance; freq relapse; 1-5% chronic carriers
Salmonella: gastroenteritis S/S most common salmonella type; 8-48 hr incubation; F, N/V, crampy abd pain, bloody diarrhea 3-5d; +stool cx
Salmonella: bacteremia S/S usually in immunocompromised pt; recurrent fever, local infxn (bone, joints, lungs)
Created by: Abarnard
 

 



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