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99 Cards in this Set
- Front
- Back
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How common are pediatric GI illnesses
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2-3/per child per year in developed countries
10-18/per child per year in developing (age 0-5) |
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Responding to epidemic
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Clinically - what is the syndrome
Epi - how is it being spread Diagnostically - what is the cause Public health - how can this be stopped/prevented |
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Upper GI syndrome
symptoms and etiology |
Prominent N/V
Rapid onset Etiology: Viral (norovirus, rotavirus) Heavy metals Preformed toxins |
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Lower GI syndrome
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Acute infectious diarrhea
Less than 2 weeks in duration >2 unformed stools/day Fecal/oral Most commonly food born spread |
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Dysentery
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Frequent, small, painful stools containing blood/mucus
Implies invasion of bowel mucosa |
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Norovirus
Symptoms |
Nausea, cramps
Diarrhea - predominant in adults Vomiting - predominant in kids Duration 12-60 hours, incubation 1-2 days |
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Most frequent foodborne illness in US
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Norovirus
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This is probably a norovirus outbreak...
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>50% of patient are vomiting
Lasting 12-60 hours Incubation 24-48 hours Stool negative for bacteria/parasites |
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Controlling an norovirus outbreak
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Diagnose with PCR on cultures
Stop group activities Hand hygiene |
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Rotavirus clinical syndrome
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Severe diarrhea in kids <2 years
Highly contagious Inclubation 2 days, illness 4 days Survives well on surfaces |
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Diagnosing and preventing rotavirus
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Diagnose via ELISA
Prevent with vaccine |
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Rotavirus epidemiology
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Most death in:
South Asia Western/Eastern Africa 3.5 million cases/year in US |
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Normal enteric flora
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>99% anaerobic bacteria
Clostridia, bacteriodes, lactobacillus E. coli, klebsiella, enterococcus, proteus Work synergistically with innate immunity Loss of normal flora shifts towards gram neg aerobes and yeast |
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Who has defects in normal GI flora
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Newborns
Pts on antibiotic Pts on chemotherapy |
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Non-inflammatory infectious diarrhea
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Enterotoxin mediated
Watery diarrhea with no fecal WBCs Effecting proximal small bowel Vibrio cholera ETEC C. perfringens Bacillus cereus Rotavirus Giardia Cryptosporidium |
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Inflammatory infectious diarrhea
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Toxin/invasion mediated
Dysentery w/ fecal WBCs Effecting terminal ileum/colon Shigella Salmonella non-typhi Campylobacter EHEC EIEC Yersina enterolitica Vibrio parahemolyticus C. diff Entamoeba histolytica |
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Penetrating infectious diarrhea
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Enteric fever w/ fecal WBCs
Effects distal small bowel Salmonella typhi Yersinia enteroliticia |
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Food borne illness epi
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More common and dangerous in old and young
Salmonella, campy, shigella are most common |
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Food borne illness with highest mortality?
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Listeria has highest case fatality rate
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Upper GI syndrome < 2 hours after eating
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Heavy metal contamination
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Upper GI syndrome 1-6 hours after eating?
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Staph aureus
B. cereus |
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Lower GI syndrome 8-14 hours after eating?
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C. perfringens
B. cereus |
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Lower GI syndrome > 14 hours after eating?
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V. cholera
ETEC/EIEC Shigella |
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Upper/lower GI syndrome > 14 hours after eating?
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Salmonella non-typhi
Vibrio parahemolyticus |
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Food contaminants causes extraintesttinal symptoms
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Scrombotoxin <2 hours til onset
Shellfish toxin <2 hours Mushroom toxin - early or hours later Ciguatoxin - 1-6 hours later Clostridium botulinum - >14 hours |
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Food borne contaminants with low innoculum needed
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Shigella
Giardia Cryptosporidium STEC (EHEC with shiga toxin) Norovirus |
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Food borne contaminants with high innoculum needed
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Salmonella
Campylobacter Cholera ETEC - really need to drink this to get it |
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Salmonella non-typhi species
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S. enteritidis, s. typhimurium, s. paratyphi, s. cholerasius
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Salmonella non-typhi syndrome
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Gasteroenteritidis with sudden onset of nausea, crampy abdominal pain, diarrhea, fever
6-48 hours after ingesting contaminant |
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Salmonella non-typhi virulence
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Pili adhere to small bowel
Enterotoxin stimulates fluid production |
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Salmonella non-typhi sources and diagnosis
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Animal reservoirs
eggs, fruit, vegetables Diagnosis : stool culture |
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Salmonella typhi appearance
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Gram negative, flagellated
Facultative anaerobe |
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Salmonella typhi syndrome
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Systemic illness
Insidious onset of malaise, myalgias, HA, high prolonged fever Most have diarrhea Rose spots Temperature pulse dissociation Case fatality 1-30% |
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Salmonella typhi transmission and pathogenesis
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Human reservoir only
Human fecal contamination is source Invades small bowel mucosa (can perforate) Spread to blood and lymphatics Chronic carrier state - lives in biliary tree |
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Diagnosing salmonella typhi
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Blood cultures
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Campylobacter syndrome
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Incubation 1-7 days
12-24 hour prodrome of HA, myalgias, fever, then acute diarrhea w/ >10 loose stools, non-bloody stools/day Lasts 5-7 days |
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Campylobacter site and reservoir
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Invades ileum, colon
Animal reservoirs, also water, unpasteurized milk - a lot like salmonella |
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Campylobacter diagnosis
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Stool culture
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Shigella clinical syndrome
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Malaise, HA, abdominal pain
High fever, acute, blood dysentery Incubation 6-72 hours |
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Shigella micro
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Gram neg rod
Facultative intracellular Human reservoir S. dystenteriae, S. flexneri, S. sonnei, S. boydii |
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Shigella at risk groups
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Children in daycare
MSM poor sanitation |
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Shigella pathogenesis
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Superficial destruction of colonic epithelium
Toxin - shiga- damages vascular endothelial cells |
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Frank blood in diarrhea
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Think Shigella, EHEC
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EHEC
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Enterohemorrhagic E. coli
Median incubation 3-4 days Cytotoxin causes bloody stool if this is shiga toxin -- STEC Transmitted via consumption of undercooked, contaminated meat |
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EIEC
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Enteroinvasive E. Coli
Invasive of bowel wall Closely related to Shigella Incubation 2-3 days |
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EAEC
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Enteroaggregative E. Coli
Persistent diarrhea in kids In US, but not commonly |
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EPEC
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Enteropathogenic E. coli
Pediatric diarrhea, hospitalized infants < 4 months Insidious onset after days of poor feeding Adheres to microvilli and destroys them |
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Cholera
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Non inflammatory toxin acts on small bowel
Increases cAMP Isotonic fluid loss Profuse, rice water diarrhea for 5 days |
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Vibrio parahemalyticus
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24 hours after eating poorly cooked seafood
Explosive water diarrhea, low grade fever |
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Yersinia enterolytica
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Fever and abdominal cramps in 24-48 hours
Some have n/v Adults - appendicitis like Kids - diarrhea Lasts 1 day to 4 weeks |
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Yersinia enterolytica culture
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Flat, colorless/pale pink
1-2 mm in diameter Lactose neg |
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Clostridium botulinum
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N/V/D
Descending flaccid paralysis 18-36 hours after consumption Toxin inhibits ACh release from nerves Associated with canned food |
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Clostridium botulinum complications
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Respiratory paralysis
Need for weeks-months of ventilation |
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Listeria monocytogenes
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Incubation is 2-6 weeks
Fever, abdominal pain, watery diarrhea, myalgias, meningitis in infants, elderly, immunocompromised |
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Treat listeria with?
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Ampicillin
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Giardiasis
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Bloating, abdominal discomfort and distention, diarrhea
Last 1-8 weeks Incubation 9 days Risk groups: hikers, childcare, MSM |
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Cryptosporidium GI syndrome
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Diarrhea, abdominal pain, HA, fever
Incubation 7 days, lasts 10-12 Immunocompromised |
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Diarrhea in hiker?
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Giardia
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Diarrhea in international traveler?
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ETEC
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Diarrhea in amphibian lover?
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Salmonella
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Diarrhea from anal sex?
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Shigella (GC, HSV, CT, TP)
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Diarrhea on cruise ship?
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Norovirus
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Diarrhea from playing with toddlers?
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Rotavirus
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GI illness after raw oysters?
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V. parahemolyticus
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GI illness after raw cookie dough?
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Salmonella non-typhi
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GI illness after raw hamburger?
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EHEC
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GI illness after fresh salsa?
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Hep A
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GI illness after leftover fried rice?
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B. cereus
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GI illness after unpasteurized cheese?
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Listeria
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GI illness after canned veggies?
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C. botulinum
Also prominent would be the paralysis |
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Diarrhea in AIDS
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Cryptosporidium
Microsporidium Cylcospora Isospora |
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Frequent rice-water stools?
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Cholera
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Infectious cause of abdominal bloating?
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Giardia
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Infectious cause of appendicitis syndrome?
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Yersina enterolitica
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What do fever and severe abdominal pain in presence of diarrhea imply?
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Invasive disease
(Salmonella, shigella, campy) |
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Infectious cause of tenesmus?
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Shigella
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Diagnostic testing in diarrhea
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Fecal WBCs
Then stool culture O and P If all neg and symptoms persist, consider scope |
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Culturing vibrio
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Requires TCBS agar
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Culturing Yersinia
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Requires cold enrichment
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Diagnosing C diff
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Toxin testing
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Treating acute GI illness
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REHYDRATE
Antibioitics only if severely ill, immunocompromised, fever and bloody stool |
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Histamine fish poisoning (scromboid)
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Causes mouth/throat burning, flushing, dizziness, n/v/d
5- 60 minutes later Lasts for a few hours Happens in coastal states |
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Ciguatera poisoning
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Fish toxin
Numbness and tingling of lips and extremities V/wateryD, cramps 1-6 hours later Lasts for days - months Florida and Hawaii |
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Paralytic shellfish poisoning
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Paresthesias of mouth and extremities
Vertigo, HA, N/V/D 5 min- 4 hours after eating mollusks Lasts hours-days Occurs in the coastal states |
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Neurotoxic shellfish poisoning
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Coastal florida
Less bad version of paralytic shellfish poisoning |
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Tetrodoxin poisoning
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Neurotoxin
Lethargy, paresthesias, dysphagia Japanese puffer fish Onset 10 min - 3 hours Lasts a few days |
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Hemolytic uremia syndrome
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Hemolysis and renal failure
Occurs as Shigellla or EHEC diarrhea is starting to resolve 8-13% of cases Fever, leukocytosis, thrombocytopenia More in kids/elderly 4% fatality |
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Campylobacter post infectious complication?
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Guillaine barre
1-3 weeks later |
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Reactive arthritis diarrhea pathogens
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Salmonella
Yersinia Campy Shigella |
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Most frequent cause of diarrhea worldwide?
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ETEC
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Top 5 foodborne pathogens
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Salmonella
Norovirus Shigella C perfringens Staph aureus |
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What food gets contaminated with staph
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Ham
Poultry Mayo Cream pastry |
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What food gets B cereus
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Fried rice
Vegetable Beans |
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What food gets C perfringens
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Beef
Poultry Legumes Gravy |
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Treating shigella
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Ampicillin
TMP/SMX, cipro in resistance Don't give antimotility |
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Treating salmonella typhi
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Ampcillin
TMP/SMX Cipro Or prevent with live oral vaccine |
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Treating salmonella non-typhi
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Usually you don't
Can use TMP/SMX or cipro in vulnerable patients |
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Treating C diff
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Metronidazole
Vanco if not responding |
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Treating yersinia enterolitica
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Tetracycline
TMP/SMX |
