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63 Cards in this Set
- Front
- Back
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median incidence of episodes of diarrhea age 0-4
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3.2 episodes
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risk factors for diarrhea
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lg family malnutrition
failure to receive ORT low weight for complications length |
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infectious etiologies for acute diarrhea in developing area
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rotaviruses 5-45%
norwalk like 1-2% enteric adenovirus 5-10%(<4) Enterotoxic Ecoli 7-50% Enteropath Ecoli 4-8% Campylobacter 2-14% shigella 5-16 salmonella 0-15% yersinia, vibrio, cdiff 1-6% other parasites crypto, giardia, strongy E histolytica |
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what age group is at highest risk of dying from diarrhea
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<1 year
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which agents are biggest problem in developed and developing areas
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rota major in 1st & 3rd
norwalk develped entero > developing parasites - depends on env niche |
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daycares see what organisms causing diarrhea
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shigella, camp,claustridium, giardia, crypto,, rota
shigella only takes 10 organisms to infect |
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what are the factors affecting diarrhea in malnourished kids
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lower gastric acidity dec mucosIgA
dec T cell func delayed muc recov persistent lactose malabsorp |
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what old thought about malnutrition is not true
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> incidence diarrhea/> complications
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what are characteristics of infectious colitis
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small volume, bloody stools with fecal leukocytes, fever and abdom pain
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What produces inf colitis invasion
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toxins = > inflammation and damage
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what etiologies of infestious colitis
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shigella, campylobacter, eiec, salmonella, e histolytica
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diagnostic eval for infectious colitis
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1 history/phys xam, assess hydrat
2 cbc diff - lt shift suggests shig 3 fecal leuko smear(false pos in BF) 4 fecal gross/occult blood testing |
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what is the definitive dg eval for inf colitis
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stool for shigella and salmonella
macConkey, agars for yersinia campy, (almost anaerobe) for campylo missed often, need to grow on blood agar with abiotics for aerobes Ecoli - toxin on sorbitol-neg |
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what else should you look for if colitis is prolonged or if other risk factors present?
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3 O&P for E histolytica or trichuris
if pt on broad spec abiots, look for clostridium |
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how do you treat infectious colitis
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NOT ANTIMOTILITY AGENTS
metroidazole for Ehistolytica, cdifficile zith for Cjejuni Cephalasporins for shigella |
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talk about secretory diarrhea
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large volume, watery stools, low or no fever, usually no leukocy or blod.
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what causes secretory diarrhea
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enterotoxins that stimulate secretions of na and Cl = water loss to balance osmotic load. V Cholera, EntoxEcoli, rota
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describe osmotic diarrhea
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watery due to damage of brush boarder microvilli, loss of disacch and carbo malabsorption. classically, viral agents, maybe protozoan(giardia), EPEC or EAEC(Ecolis)
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what is diagnostic eval for watery diarrhea
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hx/phys/fecal leuk as in inflammatory colitis.
rotavirus EIA, if at risk, Vibrio or rapid agglut/agn |
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how to treat watery diarrhea
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1 rehydration
2 abiotics tetra, doxy, cipro or bactim - cholera zith, cefixime, quinolong for travelers |
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talk about ETEC - E coli enterotoxigenic
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traveler's diarrhea
food/h2o contam w feces heat labile toxin(LT) & ST(heat stabile) self limiting, cipro may help |
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talk about EPEC AND EAEC
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EPEC epidemic diarhea in newborns
O serotype EAEC - ass with chronic diarrhea, malnutrition in dev countries - stick to brush boarder, causing malabsorption |
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talk about EIEC AND EHEC
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EIEC - Enteroinvasive, like shigella but Ecoli - needs higher doeses.
EHEC - hemorrhagic colitis and hemolytic-uremic synd, low inoculum, shiga toxin, outbreaks form uncooked meats, apple cider, raw vegs. abiotics does not prevent prog to HUS |
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talk about Cdifficile
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caused by overgrowth from overuse abiotics. Asymptomatic inf in infants common(50%0, <5% of healthy kids over age 2)
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talk about C difficile dx and tx
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two toxins(a and b)
tx - stop implicated abiotic, iv or po metronidaole |
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talk about C perfringens
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food poisoning with watery diarrhea, fever and vomit are uncommon(distg from shigella and salmonella)
raw poultry and meat, preformed toxin, fast. tx: hydration |
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talk about vibrio cholerae
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profuse, watery diarrhea by hi level enterotox production Group O1.
adults have lg vol loss/hypertens |
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how cholera transmitted
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waterborne, not person-person
lg volume, rice-water stools with fishy smell, electrolyte disturb, hypoglycemia |
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how tx cholera
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Tetra, doxy, TMP/SMX
live attenuated vacines more effect than heat killed |
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talk about other vibrios
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V parahemolyticus -diarr from raw seafood
V vulificus wound infection, esp in saltwater or marine animals |
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talk about Shigella
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classic invasive, kids 1-4 summer/fall
transmission:oral-fecal or food low inoculum food spoils |
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talk about Shigella findings
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watery diarrhea evolving into dys
hi fever lowered seizure thresh, marked left shift, bloody diarrhear with sheets of polys. intense inflam, but not deep penetration(bacteremia rare) complx: reactive arthr/Reiter's syn/rectal prolapse |
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other types of shigella
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S dysebteruae type 1 - hemolytic-uremic syndrome
all shig complications due to inflam and response(like whipworm) |
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Talk about Salmonella enteritis
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caused by S cholerasuis, S enteritidis
Foodborne, poultry/livestock/reptiles/pets fever and watery early/dys at later stage |
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what is Reiters'
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arthritis, uvicitis, urethris
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how does Salmonella invade
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10 5th orgnisms, ivdes intestine to LP w/o destructions, risk of bacteremia
intracell orgnism, with relative abiotic resistance |
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how to treat salmonelosis
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<3 months, Rx based on susceptibilities - amox, ampi, bactim, cefotaxime, ceftriaxone
resistant strains - fluoroquinolones |
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how to treat typhoid
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ampi, chloro, bactrim /corticos for sever inf with CNS
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what are not indicated for salmonelosis tx
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cephalexin, amingoglycosides, furazolidone, 2nd gen cephalosporins
never chloramphenicol (hi risk for aplastic anemia) |
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Talk about other Salmonella infs - meningitis and osteomyelitis
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men - exclusive to newborns, 3rd gen cephs, prolonged tx
osteo-sickle cell dx, galactosemia and iron verload states |
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talk about Campylobacter Jejuni and who it affects
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kids <1, microaerophilic vibrio(high temp to isolate), fecal-oral, animal vectors, invades mucosa superficially, watery diarrh, occ bloody stools w/o diarrhea
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Campy complications?
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Guillan-Barre Syndrome-neuro
Reactive arthritis Erythema nodosum |
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tx for campy compli
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zith
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what is campy fetus and how treated
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environmental campy, not animals
ass with septicemia newborns blood culture, not stool tx: aminoglycosides, imipenem or meropenem |
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talk about yersinia enterocolitica
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enterocolitis, cooler climates
animal reservoirs(rodents/birds/swine) - poorly cooked pork(chitlins), unpast milk |
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talk about dx process with yersinia enter
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bacteremia and abd abs/complications include mesenteric adenitis, pseudo appendic/E nodosum and E multiforme
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What is Rotavirus made up of and how presented
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70 mm double stranded RNA/ watery diarrhea in kids
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what are most common pedo diarrheal paths in developing countries
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rota and ETEC
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Describe pathogenesis of rota
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infects small bowel epi cells
shortened villli, sloughing of epi cells, replaced by immature crypt cells brush border def and malabsorption=osmotic diarrhea |
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three types of diarrhea
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OSMOTIC
SECRETORY INFLAMMATORY |
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does Rota produce a toxin and what does that produce
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enterotoxin with secretory diarrhea
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age group for rota
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6-36 months, rare in infants <4 mos(passive immunity)
older kids may be asymptomatic winter in temperate/year round in tropics |
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what is transmission route
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fecal-oral/person-person/respiratory?/food and water outbreaks rarely described.Nosocomial in hospitals during epidemics
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describe clinical manifestations of rota
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babies <6 - asymp
6-36 mos vomiting, diarrhea, dehydration, some fever viral shed - stool before onset - 10 days. incub 12 hrs-4 days/duration 4-8 days |
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how is rota dx and what are other symptoms?
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4-7 days/may have resp symptoms/adults - travlers
dx: stool for reducing substances/ELISA |
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talk about vaccine 4 rota
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Rotashield vaccine pulled due to telescoping bowel
RotaTeq - bovine Rotarix - human live attenuated |
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What enteric adenoviruses ass with diarrheal
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40 & 41
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How Adenoviruses dx
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DNA probes/PCR assays
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talk about giardia Lamblia
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person-person/low infectious inoculum(cyst)/human and animal reservoirs/@ risk DDC/institution kids, gay males, CF
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Clinical features of Giardia
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chronic/malabsorptive diarrhea(greasy fat stool - fat malabsorption)
recurrent diarrhea disaccharidase def/dx by microscopy., ELISA, stool or 'string' test |
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how to treat giardia
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1 furaolidone/
2 metronidazole(flagyl) 3 paromomycin for pg women/bowel eff/ not absorbed 4 albendazole 5 quinacrine - most toxic/most effective many times need to retreat |
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What is E histolytica and what does it cause
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parasitic parasite with GI inf/may be asymp - acute colitis-liver abscess.
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What is causative form in E histolytica and ages infected
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cyst is dormant/encapsulated.
Trophozoite is classic dystenery. fecal-oral/extremes of age/ pg women |
