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Infection > Infectious diarrhoea > Flashcards

Infectious diarrhoea Flashcards

1
Q

What is the definition of diarrhoea?

A

Increased fluidity & frequency

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2
Q

What is the definition of gastro-enteritis?

A

3 or more loose stools/ day

Accompanied with abdominal pain & bloody stools)

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3
Q

What occurs with dysentery?

A

Large bowel inflammation

Bloody stools

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4
Q

What type of stool is diarrhoea classified as by the bristol stool chart?

A

Type 7

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5
Q

What are some of the causes of gastro-enteritis?

A

Contamination of foodstuffs (chicken)
Poor storage of produce
Travel related infections
Person to person spread

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6
Q

What is the commonest bacterial pathogen which causes diarrhoea?

A

Camplyobacter

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7
Q

What are the most common causes of infectious diarrhoea?

A

Campylobacter
Salmonella
E.coli o157

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8
Q

What are some of the defences against enteric infections?

A

Hygiene
Stomach acid
Normal gut flora
Immunity

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9
Q

What effect do antacids have on infection?

A

More at risk of gastro-enteritis due to loss of protective acid

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10
Q

What effect do ABIs have on infection?

A

Increase risk of C. diff & diarrhoea

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11
Q

What are the 3 main clinical features of diarrhoea illness?

A

Non-inflammatory/ secretory
Inflammatory
Mixed

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12
Q

What is a secretory (non-inflammatory) form of diarrhoea illness?

A

Cholera

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13
Q

What is an inflammatory cause of diarrhoea illness?

A

Shigella dysentery

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14
Q

What infection demonstrates a mixed picture of diarrhoea disease?

A

C. diff

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15
Q

What is the mechanism of action of secretory toxin-mediated diarrhoea?

A

Increases cAMP levels & Cl secretion

Osmotic effect leads to massive water loss

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16
Q

What is the main treatment of secretory diarrhoea?

A

Rehydration therapy

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17
Q

What are the mechanisms of action of inflammatory diarrhoea disease?

A

Inflammation & toxin damage leads to mucosal destruction
Pain & fever

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18
Q

In a history, when is it unlikely to be infectious diarrhoea?

A

> 2 weeks duration

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19
Q

How can you assess hydration of patient with diarrhoeal disease?

A

Postural BP
Skin turgor
Pulse

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20
Q

What are some of the electrolyte imbalances which can occur in diarrhoea?

A

Hyponatreamia

Hypokalaemia

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21
Q

What investigations could be done in a patient with diarrhoeal disease?

A 
Stool culture
Blood culture
Renal function 
Blood count 
Abdominal Xray
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22
Q

What are some of the differential diagnosis of diarrhoeal disease?

A

Inflammatory bowel disease
Spurious diarrhoea (secondary to constipation)
Carcinoma

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23
Q

In what incidence can diarrhoea & fever occur?

A

Sepsis outside the gut

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24
Q

What are some of the treatment options for gastro-enteritis?

A

Oral rehydration therapy

IV saline

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25
Q

What is the commonest cause of gastro-enteritis?

A

Campylobacter

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26
Q

How long is the incubation period of campylobacter gastro-enteritis?

A

7 days

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27
Q

How long does it take for campylobacter to clear from the gut?

A

6 weeks

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28
Q

Is campylobacter invasive/ non-invasive?

A

Non-invasive

29
Q

What are some of the post-infection diseases which can occur following campylobacter gastro-enteritis?

A

Guillain-Barre syndrome

Reactive arthritis

30
Q

What are the mechanisms for bacterial culture?

A

Molecular detection

Antigen detection

31
Q

What are the 2 types of campylobacter which are most commonly the source of infection?

A

C. jejune (90%)

C. coli (9%)

32
Q

What is the commonest cause of bacterial food poisoning in the UK? What are the main sources?

A

Campylobacter

Chicken, contaminated milk,

33
Q

When do symptoms of salmonella gastroenteritis occur within?

A

<48hrs after exposure

34
Q

How long does Salmonella diarrhoeal disease last?

A

10 days

35
Q

How long could stools be positive for salmonella following disease?

A

20 weeks

36
Q

What are the most common species of salmonella?

A

S. enterica

S. bongori

37
Q

How are salmonella species screened in lab?

A

Lactose non-fermenters (biochemical testing)

38
Q

How can E.coli O157 be contracted?

A

Contaminated meat

Person-to-person

39
Q

How is E.col O157 typically characterised?

A

Frequent bloody stool

40
Q

What toxin is produced by E.coli O157?

A

Shiga toxin

41
Q

What is responsible for E.coli O157 infection?

A

Toxin - moves into the blood

E.coli remains in the gut

42
Q

What syndrome can the shiga toxin cause?

A

Haemolytic -uraemic (HUS) syndrome

43
Q

What is NOT recommended in the treatment of E.coli O157?

A

ABIs - causes increased lysis of the bug therefore increases the risk of toxin release

44
Q

What does shiga toxin stimulate in the blood?

A

Toxin stimulates platelet activation

Micro-angiopathy

45
Q

What other forms of E.coli cause diarrhoea?

A

Enteroinvasive
Enteropathogenic
Enterotoxic (travellers diarrhoea)

46
Q

How can E.coli O157 be distinguished from other strains?

A

Non-sorbitol fermenting

47
Q

What are some of the occasional cause of food poisoning outbreaks?

A

S. aureus
Bacillus cereus (rice)
C. perfringens (meat)

48
Q

When could ABIs be used in gastroenteritis?

A

Immunocomprised
Severe sepsis or invasive infection
Chronic illness eg malignancy

49
Q

When are ABIs not advised in gastroenteritis?

A

In an healthy patient with non invasive infection

50
Q

What ABIs are associated with C diff diarrhoea infection?

A

4Cs : cephalosporin, co-amoxiclav, clindamycin, ciprofloxacin

51
Q

What are the toxins produced by C. Diff?

A

Enterotoxin

Cytotoxin

52
Q

What are the main treatments for C diff infection?

A

Metronidazole

Oral Vancomycin

53
Q

Which ABI is normally administered IV but used orally in C. diff infection?

A

Vancomycin

54
Q

What important actions should be taken with a patient with C. diff?

A

Isolate symptomatic patient
Wash hands between patients
Contact precautions

55
Q

How should you manage C. diff?

A

Stop precipitating ABIs

Oral metronidazole or vancomycin

56
Q

What are some examples of parasites?

A

Protozoa or helminths

57
Q

How are parasites usually diagnosed?

A

Microscopy

Stool sample - parasites, cysts & ova (P,C,O)

58
Q

What symptoms are observed in parasite disease (G. lambia)?

A

Diarrhoea
Malabsorption
Gas
Failure to thrive

59
Q

How are parasites transmitted?

A

Direct contact with animals or people

Contaminated water/ food

60
Q

How are parasites treated?

A

Metronidazole

61
Q

What does entamoeba histolytica cause?

A

Amoebic dysentery

62
Q

What parasite causes liver abscess?

A

Entamoeba histolytica (anchovy pus)

63
Q

What are the different types of viral diarrhoeal disease?

A

Rotavirus
Norovirus
Adenovirus

64
Q

What population does Rotavirus usually affect?

A

Children under 5 yrs

65
Q

When did cases of rotavirus decrease significantly?

A

Introduction of vaccination

66
Q

Where can outbreaks of norovirus usually occur?

A

Institutions, hospitals, community & cruise ships

67
Q

How can norovirus be diagnosed?

A

PCR

68
Q

How can spread of norovirus be controlled?

A

Strict infection control

Infection (7 decks)

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