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2010-07-14 #1.3

Microbial pathogens causing diarrhea

QuestionAnswer
CC of diarrhea in AIDS when CD4 T cell count < 50~100 cells/mm^3: Rx? ganciclovir (CMV)
MCC of "adult" gasroenteritis; common infection on "cruise ships": MOT? fecal-oral transmission (Norwalk virus)
MCC of "childhood" diarrhea in winter months: pathogenesis? type of diarrhea? damaged ion transport pump in small intestine; secretory diarrhea
Rx & ProRx: rotavirus? rotavirus oral vaccine; oral hydration; nitazoxanide
gram[+] rod; reheated fried rice or tacos: Dx? preformed toxin of bacillus cereus
curved[S] shaped gram[-] rod; cattle, chicken, puppies(for children); fecal-oral transmission; MC food-borne illness & invasive entercolitis in US: type of diarrhea? invasive & secretory enterocolitis: dysentery + crypt abscesses & ulcers resembling ulcerative coliti (Campylobacter jejuni)
Rx: Campylobacter jejuni azithromycin
associated with Guillain-Barre syndrome; hemolytic uremic syndrome; HLA-B27 ankylosing spondylitis: Dx? Campylobacter jejuni
preformed toxin: block release of acetylcholine release in presynpatic terminal of neuromuscular junction in ANS; descending paralysis, mydriasis, dry mouth: Dx? Clostridium botulinum
spores: floppy baby with constipation: Rx? trivalent antitoxin (Clostridium botulinum)
MCC of nosocomial diarrhea: Ax? type of diarrhea? toxin? pseudomembranous colitis; secretory type (Clostridium difficile); exotoxin A & B
antibiotic causing C.difficile overgrowth? ampicillin; quinolones; clindamycin (Clostridium.Q&A)
Rx: Clostridium difficile metronidazole; vancomycin
undercooked beef; hemolytic uremic syndrome: Rx? STEC(O157:H7 serotype); antibiotics X recommended; may enhance toxin release
diarrhea with malabsorption in AIDS when CD4 count < 50 cell/mm^3: complication? foamy macrophages in lamina propria > "Whipple's disease" (Mycobacterium avium-intracellulare complex)
acid fast organisms? MAC; Mycobacterium tuberculosis
invasion into Peyer's patches; circumferential spread in lymphatics lead to complication: Dx? M.tuberculosis; acid-fast
2nd MC food-borne illness in US; raw or undercooked "egg" products, raw milk, milk products, poultry or contaminated water: reservoir? animal reservoir: turtles, hamsters, lizards
Rx: Salmonella enteritidis enterocolitis ciprofloxacin or levofloxacin
invasion into Peyer's patches; sepsis: best diagnostic? blood culture at week 1 in typhoid fever by S.typhi
triad of bradycardia; neutropenia; splenomegaly and diarrhea: Rx? if symptomatic: luoroquinolone (S.typhi = typhoid fever)
no animal reservoir; highly infectious in day care centers; mucosal ulceration + pseudomembranous inflammation in rectosignoid, dysentery: Ax? seronegative spondyloarthropathy (Shigella sonnei)
Rx: Shigella sonnei if symptomatic: fluoroquinolone or azithromycin
azithromycin Shigella sonnei; Campylobacter jejuni
preformed toxin-mediated food poisoning; gastroenteritis in 1 to 6 hrs after eating; diagnostic? culture "food", X "stool"
enterotoxin stimulating adenylate cyclae in small bowel; contaminated water or seafood (esp, crustacea): morphology? Rx? gram[-] comma-shaped rod; fluid replacement; glucose & sodium in oral supplement (cotransport system for absorption); doxycycline or fluroquinolone
fluoroquinolone Salmonella; Shigella; Vibrio cholerae
gram[-] coccobacillus with bipolar staining; granulomatous microabscesses; mimicks acute appendicitis: Dx? Yersinia enterocolitis
association with HLA-B27 positive seronegative spondyloarthropathy & seropositive spondyloarthropathy Shigella sonnei & Yersinina enterocolitica; Campylobacter jejuni
TMP-SMX Y.enterocolitica; Cyclospora; Isospora
transmitted by ingestion of "cysts" in food or water Balantidium coli; Cryptosporidium parvum(oocysts); Entamoeba histiolytica; Giardia lamblia
largest "ciliated" protozoa; colonic ulcer with bloody diarrhea: Dx? Balantidium coli
MCC of diarrhea in AIDs; partial acid-fast; outbreaks of diarrhea in water supply (Milwaukee, Wisconsin): Dx? Cryptosporidium parvum
Rx: Cryptosporidium parvum nitazoxanide
fecal-oral transmission; common in AIDs diarrhea; partially acid-fast oocysts; raspberries Cyclospora
fecal-oral transmission; common in AIDs diarrhea; non partially acid-fast: Rx? Microsporidia; albendazole
nonmotile cysts formed in stool; dysentery; flask-shaped ulcers; "anchovy paste" abscess; RBCs in trophozoites: Dx? Rx? Entamoeba histiolytica; metronidazole
Nitazoxanide Giardia lamblia; Cryptosporidium parvum
MCC protozoal cause of diarrhae in US; day care centers, hikers, water supplies, homosexual, IgA deficiency, CVID; acute and chronic diarrhea with malabsorption: Dx? Giardia lamblia
Rx: Giardia lamblia tinidazole or nitazoxanide
ingestion of eggs in helminths Enterobius vermicularis; Trichuris trichiura; Ascaris lumricoides
diarrhea with B12 deficiency; ingestion of larvae (fish) in lake trout (Great Lakes): Dx? Rx? Diphyllobothrium latum; praziquantel
bare feet; larval phase through lungs; autoinfection; massive reinfection in IC patients; abdominal pain & diarrhea: Dx? Strongyloides stercoralis
Rx: Strongyloides stercoralis ivermectin
blood loss; iron deficiency; intestinal nematode: term? Rx? Necator americanus; albendazole or mebendazole
raw fish dishes (sushi, sashimi); pickled herring; cramping abdominal pain with epigastric distress; IgE antibody test: Dx? Anisakis simplex
MC helminth in US; pruritus ani; urethritis in girls; acute appendicitis; X eosinophilia: Dx? non invasive Enterobius vermicularis
rectal prolapse in children; eosinophilia Trichuris trichiura (Whipworm)
eosinophilia Trichuris trichiura; larval phase of Ascaris lumbricoides
albendazole and/or mebendazole E.vermicularis; T.trichiura; N.americanus; A.lumbricoides for both
Created by: mataos