GI Infections (Traveler's Diarrhea, Food Posioning)
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| What are the 3 important host defenses | normal flora, gastric pH, and intestinal motility
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| 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)
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| What are the 4 steps to management of GI infection | Prevention
Rehydration
Symptomatic Relief
Antimicrobial Therapy
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| What is the cornerstone of therapy for diarrhea | Rehydration
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| 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
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| When do you use Oral Rehydration Therapy and when do you useIV therapy? | ORT for mild-to-moderate diarrhea
IV therapy for severe diarrhea
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| What 5 things should ORT contain | glucose, sodium, potassium, chloride, water
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| 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)
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| Which is preferable for IV therapy and why LR or NS | LR helps to correct metabolic acidosis
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| When should you avoid the use of antimotility agents (ie loperamide) | if patient has fever, bloody stools, and/or fecal leukocytes
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| When is loperamide contraindicated and why? | toxin-producing infections (EHEC, pseudomembranous colitis, shigellosis, etc.)
may cause increased exposure to toxins, increasing further damage
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| What is Hemalytic Uremic Syndrome (HUS) | kidney failure due to toxin produced by EHEC
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| How is non-inflammatory and inflammatory diarrhea described | non-inflammatory: watery diarrhea
inflammatory: dysenteric diarrhea (presence of blood and mucus)
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| Where do non-inflammatory and inflammatory diarrhea occur | non-inflammatory: proximal small bowel
inflammatory: colon/distal small bowel
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| fecal leukocytes and lactoferrin? | non-inflammatory: FL (-), lactoferrin no to mild
inflammatory: FL (+), lactoferrin elevated
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| What are the common pathogens of non-inflammatory diarrhea | Vibrio cholerae, ETEC, Clostridium perfringens, S. aureus, rotavirus, Cryptosporidium
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| What are the common pathogens of inflammatory diarrhea | Shigella, Salmonella, Campylobacter, EHEC, Listeria, C. diff
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| What is the DOC for campylobacter infection? What is 2nd line? | azithromycin
Fluoroquinolones
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| What 2 pathogens usually resolve in 5-7 days and don't require antibiotics in most cases | Salmonella and Shigella
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| When are antibiotics recommended for Salmonella and Shigella | severe diarrhea, bloodstream infections, hospitalized patients
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| What pathogen is a microscopic parasite commonly transmitted by water | cryptosporidium
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| What is the difference between normal gut E. coli and EHEC | EHEC produces toxins and is transmitted through contaminated food
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| What complications are caused by the toxins produced by EHEC | bloody diarrhea, kidney failure (HUS)
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| How can transmission of EHEC be prevented | cooking foods thoroughly
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| What is the most common viral cause of gastroenteritis and what is its incubation period | rotavirus 1-3 days
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| What are 2 possible management strategies of rotavirus gastroenteritis | rehydration and probiotics
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| Other than rotavirus, what other viruses can cause gastroenteritis | norovirus, enteric adenovirus, astrovirus
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| What are the most common pathogens for Traveler's Diarrhea | EHEC, Shigella, Campylobacter, Salmonella
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| What countries are cosidered low-risk for Traveller's Diarrhea | US, Canada, Australia, NZ, Japan, Northern and Western Europe
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| 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
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| Traveler's Diarrhea classification: mild | 1-3 loose stools/dy abdominal cramps lasting <14dys
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| Traveler's Diarrhea classification: moderate | >4 loose stools/dy associated w/ dehydration
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| Traveler's Diarrhea classification: severe | any number of loose stools in the presence of fever or blood in stools
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| Bismuth Subsalicylate dosing for PREVENTION of Traveler's Diarrhea | 524 mg po QID for up to 21dys
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| Why are antibiotics not routinely recommended for prophylaxis | concern for increasing resistance
false sense of security
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| 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
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| What is the most common class of antibiotics used for prophylaxis | Fluoroquinolones
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| When would you use azithromycin as prophylaxis instead of FQ's | when traveling to South and Southeast Asia due to increased FQ resistance
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| Bismuth Subsalicylate dosing for TREATMENT of Traveler's diarrhea | 525mg po q30min
up to 8doses
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| What the DOC regimen for TREATING Traveler's Diarrhea | cipro 500mg po BID x3-5dys
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| WHat is the azithromycin regimen for TREATING Traveler's Diarrhea | 500mg po qd x7dys
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| What 2 antibiotics are NOT recommended for treatment and why? | Bactrim and doxycycline
resistance
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| 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
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| What are the six most common bacterial causes of food poisoning | campylobacter, salmonella, shigella, E. coli, yersinia, vibrio
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| 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
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| What 3 bacteria can cause food poisoning where antibiotic therapy may not be effective | S. aureus, C. perfringens, B. cereus
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